Healthcare Provider Details

I. General information

NPI: 1801898598
Provider Name (Legal Business Name): ALIZABETH LECHI TRUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date: 03/22/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1400 POTTERY AVE
PORT ORCHARD WA
98366-3711
US

IV. Provider business mailing address

1400 POTTERY AVE
PORT ORCHARD WA
98366-3711
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-5000
  • Fax:
Mailing address:
  • Phone: 360-895-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA68200
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD60604631
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: