Provider Demographics
NPI:1982763181
Name:PETER T. TRUONG, M.D., INC.
Entity Type:Organization
Organization Name:PETER T. TRUONG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-434-9499
Mailing Address - Street 1:9497 N FORT WASHINGTON RD
Mailing Address - Street 2:103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0660
Mailing Address - Country:US
Mailing Address - Phone:559-434-9499
Mailing Address - Fax:
Practice Address - Street 1:9497 N FORT WASHINGTON RD
Practice Address - Street 2:103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0660
Practice Address - Country:US
Practice Address - Phone:559-434-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG710462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty