MEDICARE: QUANG TRUONG

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1396491627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUANG TRUONG

Provider Business Mailing Address
First Line	:	PO BOX 183502
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76096-3502
Country	:	US
Telephone Number	:	817-899-0301
Fax Number	:

Provider Business Practice Location Address
First Line	:	6849 SHOREWAY DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6830
Country	:	US
Telephone Number	:	817-899-0301
Fax Number	:

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

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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Directions to “ QUANG TRUONG ” Practice Location

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