Healthcare Provider Details

I. General information

NPI: 1851454722
Provider Name (Legal Business Name): TICH NGOC TRUONG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 E MOCKINGBIRD LN SUITE 314
DALLAS TX
75214-2454
US

IV. Provider business mailing address

6465 E MOCKINGBIRD LN SUITE 314
DALLAS TX
75214-2454
US

V. Phone/Fax

Practice location:
  • Phone: 214-826-8336
  • Fax: 214-826-8836
Mailing address:
  • Phone: 214-826-8336
  • Fax: 214-826-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG2867
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG 2867
License Number StateTX

VIII. Authorized Official

Name: DR. TICH NGOC TRUONG
Title or Position: OWNER
Credential: M.D.,P.A.
Phone: 214-826-8336