Healthcare Provider Details

I. General information

NPI: 1407897473
Provider Name (Legal Business Name): PHUC HUY TRUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GEORGE PHUC HUY TRUONG MD

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WARNER AVE STE 207
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

11160 WARNER AVE STE 207
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-2045
  • Fax: 714-966-9392
Mailing address:
  • Phone: 714-966-2045
  • Fax: 714-966-9392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36401
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA36401
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25537
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: