Healthcare Provider Details

I. General information

NPI: 1396376745
Provider Name (Legal Business Name): MICHAEL TRUONG, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 WARNER AVE STE 101B
FOUNTAIN VALLEY CA
92708-3846
US

IV. Provider business mailing address

340 S LEMON AVE # 8030
WALNUT CA
91789-2706
US

V. Phone/Fax

Practice location:
  • Phone: 714-263-0557
  • Fax: 213-986-9953
Mailing address:
  • Phone: 310-912-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL TRUONG
Title or Position: CEO
Credential: MD
Phone: 310-912-2305