Healthcare Provider Details

I. General information

NPI: 1952861049
Provider Name (Legal Business Name): JUSTIN TRUNG DO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 S ATLANTIC BLVD STE 101
MONTEREY PARK CA
91754-4772
US

IV. Provider business mailing address

880 S ATLANTIC BLVD STE 101
MONTEREY PARK CA
91754-4772
US

V. Phone/Fax

Practice location:
  • Phone: 626-281-6969
  • Fax:
Mailing address:
  • Phone: 626-281-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number20A19512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: