Provider Demographics
NPI:1194135236
Name:TRUONG, PHAT DIEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:PHAT
Middle Name:DIEN
Last Name:TRUONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 BRUTON RD.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217
Mailing Address - Country:US
Mailing Address - Phone:972-288-2844
Mailing Address - Fax:972-288-2850
Practice Address - Street 1:9709 BRUTON RD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217
Practice Address - Country:US
Practice Address - Phone:972-288-2844
Practice Address - Fax:972-288-2850
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program