Healthcare Provider Details

I. General information

NPI: 1649267683
Provider Name (Legal Business Name): THOMAS DANIEL TRUONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 N RIDGE RD STE 140
WICHITA KS
67205-1223
US

IV. Provider business mailing address

3460 N RIDGE RD STE 140
WICHITA KS
67205-1223
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-4330
  • Fax: 316-283-4340
Mailing address:
  • Phone: 316-283-4330
  • Fax: 316-283-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1200351
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: