MEDICARE: MIMI TRUONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	35026	CA

General Provider Information

NPI Number	:	1568133700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIMI TRUONG

Provider Business Mailing Address
First Line	:	18230 DEVONWOOD CIR
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25260 LA PAZ RD STE G
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5132
Country	:	US
Telephone Number	:	949-586-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	10/07/2021

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Directions to “ MIMI TRUONG ” Practice Location

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