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General NPI Number Information
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NPI Number | 1285937631
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Entity Type | Organization
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Legal Business Name | MIYOCO MEDICAL CENTER INC.
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 15975 HARBOR BLVD
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1303
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Country | US
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Telephone | 714-546-6575
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Fax | 714-551-9411
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Provider Business Mailing Address
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Address Line | 15975 HARBOR BLVD
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1303
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Country | US
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Telephone | 714-546-6575
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Fax | 714-551-9411
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Authorized Official
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Title or Position | OWNER
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Name | DR. HIEP TRUONG
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Credential | MD
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Telephone | 714-546-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A45852
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License Number State | CA
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