Healthcare Provider Details

I. General information

NPI: 1902818131
Provider Name (Legal Business Name): MY-LE TRUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LA PALMA AVE
ANAHEIM CA
92801-2804
US

IV. Provider business mailing address

PO BOX 1809
ORANGE CA
92856-0809
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-3828
  • Fax: 714-999-3907
Mailing address:
  • Phone: 714-560-1580
  • Fax: 714-560-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG63412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: