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	:	1932399706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER T. TRUONG, M.D., SURGICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	11999 SAN VICENTE BLVD
Second Line	:	STE. 440
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5131
Country	:	US
Telephone Number	:	310-440-3131
Fax Number	:	310-471-5852

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

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	05/19/2008

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