Provider Demographics
NPI:1104983444
Name:TRUONG, LAN THI (PA-C)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10725 INTERNATIONAL DR
Mailing Address - Street 2:DERMATOLOGY
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7967
Mailing Address - Country:US
Mailing Address - Phone:916-631-3010
Mailing Address - Fax:
Practice Address - Street 1:3300 STOCKTON BLVD
Practice Address - Street 2:CAARE CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1451
Practice Address - Country:US
Practice Address - Phone:916-734-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant