Healthcare Provider Details

I. General information

NPI: 1780901140
Provider Name (Legal Business Name): NGUYEN CAO LUU-TRONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NGUYEN CAO LUU-TRONG M.D.

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PLAZA DRIVE MAIL STOP CA124-0121
CYPRESS CA
90630
US

IV. Provider business mailing address

5757 PLAZA DR
CYPRESS CA
90630-5000
US

V. Phone/Fax

Practice location:
  • Phone: 714-504-5801
  • Fax:
Mailing address:
  • Phone: 714-504-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA50104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: