=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962592519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRUONG MD CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 04/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15568 BROOKHURST ST SUITE 368
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-7572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-866-1807
-----------------------------------------------------
Fax | 714-809-8379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15568 BROOKHURST ST SUITE 368
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-7572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-866-1807
-----------------------------------------------------
Fax | 714-809-8379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. SON N TRUONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-866-1807
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A97261
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------