Healthcare Provider Details

I. General information

NPI: 1932492444
Provider Name (Legal Business Name): RYAN QUOC TRUONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 PIERCE ST UNIT J
RIVERSIDE CA
92505-8511
US

IV. Provider business mailing address

3950 PIERCE ST UNIT J
RIVERSIDE CA
92505-8511
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-4362
  • Fax: 951-824-7595
Mailing address:
  • Phone: 951-689-4362
  • Fax: 951-824-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-28748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: