=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174583033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDY NGOC TRUONG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16027 BROOKHURST ST G-135
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-323-6446
-----------------------------------------------------
Fax | 714-844-9494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16027 BROOKHURST ST G-135
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-323-6446
-----------------------------------------------------
Fax | 714-844-9494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A66251
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------