MEDICARE: DR. LAN 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	183500000X	Pharmacist	051219	NY

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

General Provider Information

NPI Number	:	1710167812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAN TRUONG

Provider Business Mailing Address
First Line	:	10907 101ST AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11419-1029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10907 101ST AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11419-1029
Country	:	US
Telephone Number	:	718-441-9311
Fax Number	:

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

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	01/28/2009

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Directions to “ DR. LAN TRUONG ” Practice Location

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