Healthcare Provider Details

I. General information

NPI: 1689738676
Provider Name (Legal Business Name): TRUONG H. NGUYEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5746 RISING SUN AVE
PHILADELPHIA PA
19120-1626
US

IV. Provider business mailing address

5746 RISING SUN AVE
PHILADELPHIA PA
19120-1626
US

V. Phone/Fax

Practice location:
  • Phone: 215-904-6891
  • Fax:
Mailing address:
  • Phone: 215-904-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOS013684
License Number StatePA

VIII. Authorized Official

Name: TRUONG HUU NGUYEN
Title or Position: PRESIDENT AND CEO
Credential: D.O
Phone: 215-904-6891