Healthcare Provider Details

I. General information

NPI: 1417878224
Provider Name (Legal Business Name): KEVIN HOANG-KHANH TRUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WASHTENAW AVE
ANN ARBOR MI
48104-4201
US

IV. Provider business mailing address

41459 BURROUGHS AVE
NOVI MI
48377-2861
US

V. Phone/Fax

Practice location:
  • Phone: 734-975-2902
  • Fax:
Mailing address:
  • Phone: 248-231-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: