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General NPI Number Information
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NPI Number | 1558578948
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Entity Type | Individual
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Provider Name | KIM PHUNG TRUONG D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 27800 MEDICAL CENTER RD
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6410
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Country | US
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Telephone | 949-364-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 2763 ASCOT AVE
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City | CARLSBAD
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State | CA
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Zip | 92009-3087
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Country | US
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Telephone | 760-804-9392
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A8106
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License Number State | CA
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