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Individual
DR. THAN VAN TRUONG
Active
Individual
DR. THAN VAN TRUONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E4636
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BO152Y
MEDICARE PTAN
CA
05
—
GRE001780
—
CA
01
—
W17007
MEDICARE GROUP
—
Enumeration date
05/19/2006
Last updated
03/07/2013
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