Provider Demographics
NPI:1982768925
Name:TRUONG, CUONG QUOC (OD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:QUOC
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 LOS CERRITOS MALL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5425
Mailing Address - Country:US
Mailing Address - Phone:562-865-2020
Mailing Address - Fax:
Practice Address - Street 1:326 LOS CERRITOS MALL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5425
Practice Address - Country:US
Practice Address - Phone:562-865-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12415T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98859Medicare UPIN