Provider Demographics
NPI:1386713980
Name:TRUONG, MINH Q (OD)
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:Q
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HARBOR BLVD
Mailing Address - Street 2:C 4
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3343
Mailing Address - Country:US
Mailing Address - Phone:714-554-0202
Mailing Address - Fax:714-554-0203
Practice Address - Street 1:100 N HARBOR BLVD
Practice Address - Street 2:C 4
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3343
Practice Address - Country:US
Practice Address - Phone:714-554-0202
Practice Address - Fax:714-554-0203
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11321T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0113210Medicaid
CASD0113211Medicaid
CASD0113211Medicaid