Provider Demographics
NPI:1982719597
Name:DO, THOA TRONG (MD)
Entity Type:Individual
Prefix:DR
First Name:THOA
Middle Name:TRONG
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14350 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4608
Mailing Address - Country:US
Mailing Address - Phone:714-839-0294
Mailing Address - Fax:714-839-1082
Practice Address - Street 1:14350 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4608
Practice Address - Country:US
Practice Address - Phone:714-839-0294
Practice Address - Fax:714-839-1082
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435200Medicaid
CAA43520Medicare ID - Type Unspecified
CA00A435200Medicaid