MEDICARE: MR. KHAI C TRUONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	39284	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000623499	OTHER	KY	ANTHEM BC&BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000370768	OTHER	KY	BC/BS

General Provider Information

NPI Number	:	1003892548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KHAI C TRUONG M.D.

Provider Business Mailing Address
First Line	:	131 HOSPITAL DR
Second Line	:
City	:	SALEM
State	:	KY
Zip	:	42078-8043
Country	:	US
Telephone Number	:	270-988-7256
Fax Number	:	270-988-3900

Provider Business Practice Location Address
First Line	:	1860 JH OBRYAN AVE
Second Line	:
City	:	GRAND RIVERS
State	:	KY
Zip	:	42045-9049
Country	:	US
Telephone Number	:	270-362-8246
Fax Number	:	270-362-9757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	08/09/2016

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