Healthcare Provider Details

I. General information

NPI: 1558611525
Provider Name (Legal Business Name): HUONG TRUONG HEGDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W SPRING CREEK PKWY SUITE 150
PLANO TX
75024-4236
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 972-403-5425
  • Fax: 214-501-1252
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberP5746
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: