Provider Demographics
NPI:1528090818
Name:TRUONG, DAVID MINH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MINH
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 WARNER AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3846
Mailing Address - Country:US
Mailing Address - Phone:714-274-9969
Mailing Address - Fax:714-274-9973
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:STE 201
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-274-9969
Practice Address - Fax:714-274-9973
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74460207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G744601Medicaid
CAG74460OtherSTATE MEDICAL LICENSE
F92275Medicare UPIN
CAG74460Medicare PIN