Healthcare Provider Details

I. General information

NPI: 1245509256
Provider Name (Legal Business Name): MY-LINH TRUONG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N. MADISON AVENUE SUITE 800
PASADENA CA
91101
US

IV. Provider business mailing address

133 N. ALTADENA DRIVE 2ND FLOOR
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-3141
  • Fax: 626-792-9193
Mailing address:
  • Phone: 626-397-8300
  • Fax: 626-397-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: