Provider Demographics
NPI:1336835107
Name:TRUONG, RYAN TRUNG-DINH
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:TRUNG-DINH
Last Name:TRUONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LINCOLN ST APT 313
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2800
Mailing Address - Country:US
Mailing Address - Phone:918-527-6964
Mailing Address - Fax:
Practice Address - Street 1:232 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4133
Practice Address - Country:US
Practice Address - Phone:503-359-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA223794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty