MEDICARE: PETER T. TRUONG, M.D., SURGICAL CENTER, INC.

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1336223585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER T. TRUONG, M.D., SURGICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	9497 N FORT WASHINGTON
Second Line	:	103
City	:	FRESNO
State	:	CA
Zip	:	93730-0660
Country	:	US
Telephone Number	:	559-434-9497
Fax Number	:	559-434-9499

Provider Business Practice Location Address
First Line	:	9497 N FORT WASHINGTON
Second Line	:	103
City	:	FRESNO
State	:	CA
Zip	:	93730-0660
Country	:	US
Telephone Number	:	559-434-9497
Fax Number	:	559-434-9499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER T TRUONG
Credential	:	M.D.
Telephone Number	:	559-434-9497

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/09/2008

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