MEDICARE: DR. DONGNGAN THUY 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	208000000X	Pediatrics Physician	047786	CT
2	2080P0202X	Pediatric Cardiology Physician	100558	GA

General Provider Information

NPI Number	:	1447434006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONGNGAN THUY TRUONG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 413021
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3021
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 BRANDYWINE RD # 125
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5528
Country	:	US
Telephone Number	:	404-256-2593
Fax Number	:	770-488-9408

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/04/2024

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