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General NPI Number Information
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NPI Number | 1407987274
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Entity Type | Individual
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Provider Name | THUYTIEN THI TRUONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 11033 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-1930
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Country | US
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Telephone | 310-231-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 62 GRANT
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City | IRVINE
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State | CA
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Zip | 92620-3356
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Country | US
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Telephone | 562-857-2698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10741T
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License Number State | CA
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