Healthcare Provider Details

I. General information

NPI: 1457941874
Provider Name (Legal Business Name): LOYAL LUONG TRUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S ADAMS ST
DENVER CO
80209-2909
US

IV. Provider business mailing address

1975 19TH ST APT 5013
DENVER CO
80202-6081
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-1146
  • Fax:
Mailing address:
  • Phone: 714-234-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0003871
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: