Individual
DR. THAN VAN TRUONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
16171 BROOKHURST ST, FOUNTAIN VALLEY, CA 92708-1550
(714) 531-1434
Mailing address
16171 BROOKHURST ST, FOUNTAIN VALLEY, CA 92708-1550
(714) 531-1434
(310) 675-0904
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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