Healthcare Provider Details

I. General information

NPI: 1396183349
Provider Name (Legal Business Name): CRYSTAL NGUYEN TRUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD
HONOLULU HI
96859
US

IV. Provider business mailing address

1 JARRETT WHITE ROAD
HONOLULU HI
96859
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberR168308
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101262921
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101262921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: