Provider Demographics
NPI:1528271418
Name:TRUONG, CHI QUYNH (DO)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:QUYNH
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60041
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-6041
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1600 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3722
Practice Address - Country:US
Practice Address - Phone:805-988-2843
Practice Address - Fax:805-988-2844
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO190920207P00000X
HIDOS-1953207P00000X
TXS0392207P00000X
NC2019-00354207P00000X
AK140093207P00000X
NMA226219207P00000X
CA20A9027207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A9027CMedicare PIN
CAW20A9027BMedicare PIN
CAW20A9027AMedicare PIN
CAW20A9027EMedicare PIN