Healthcare Provider Details

I. General information

NPI: 1659380814
Provider Name (Legal Business Name): SON V TRUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N. CYPRESS
WICHITA KS
67226-4003
US

IV. Provider business mailing address

3009 N. CYPRESS
WICHITA KS
67226-4003
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-1010
  • Fax: 316-440-0802
Mailing address:
  • Phone: 316-440-1010
  • Fax: 316-440-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0428400
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number04-28400
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04-28400
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number28400
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number04-28400
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0428400
License Number StateKS
# 7
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0428400
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: