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General NPI Number Information
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NPI Number | 1740649672
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Entity Type | Organization
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Legal Business Name | LOAN T. TRUONG, M.D., INC.
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Dates
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Enumeration Date | 02/20/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 855 E ANAHEIM ST
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City | LONG BEACH
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State | CA
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Zip | 90813-3550
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Country | US
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Telephone | 562-591-0840
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Fax | 562-591-4191
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Provider Business Mailing Address
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Address Line | 855 E ANAHEIM ST
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City | LONG BEACH
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State | CA
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Zip | 90813-3550
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Country | US
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Telephone | 562-591-0840
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Fax | 562-591-4191
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOAN THANH TRUONG
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Credential | M.D.
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Telephone | 562-253-6208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 139072
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License Number State | CA
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