MEDICARE: PETER T. TRUONG, M.D., 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	2086S0122X	Plastic and Reconstructive Surgery Physician	G71046	CA

General Provider Information

NPI Number	:	1982763181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER T. TRUONG, M.D., INC.

Provider Business Mailing Address
First Line	:	9497 N FORT WASHINGTON RD
Second Line	:	103
City	:	FRESNO
State	:	CA
Zip	:	93720-0660
Country	:	US
Telephone Number	:	559-434-9499
Fax Number	:

Provider Business Practice Location Address
First Line	:	9497 N FORT WASHINGTON RD
Second Line	:	103
City	:	FRESNO
State	:	CA
Zip	:	93720-0660
Country	:	US
Telephone Number	:	559-434-9499
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER T TRUONG
Credential	:	M.D.
Telephone Number	:	559-434-9499

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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