Basic Information
Provider Information | |||||||||
NPI: | 1558323758 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TRUONG | ||||||||
FirstName: | PHU | ||||||||
MiddleName: | V | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 818 N EMPORIA ST | ||||||||
Address2: | SUITE 403 | ||||||||
City: | WICHITA | ||||||||
State: | KS | ||||||||
PostalCode: | 672143729 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3162624467 | ||||||||
FaxNumber: | 3162620706 | ||||||||
Practice Location | |||||||||
Address1: | 3243 E MURDOCK ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | WICHITA | ||||||||
State: | KS | ||||||||
PostalCode: | 672083052 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3162624467 | ||||||||
FaxNumber: | 3162620706 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/04/2006 | ||||||||
LastUpdateDate: | 09/29/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 0428992 | KS | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 1286700009 | 01 |   | DMERC REGION 1 | OTHER | 1286700011 | 01 |   | DMERC REGION 1 | OTHER | 1286700003 | 01 |   | DMERC REGION 1 | OTHER | 1286700015 | 01 |   | DMERC REGION 1 | OTHER | 1286700007 | 01 |   | DMERC REGION 1 | OTHER | 1286700008 | 01 |   | DMERC REGION 1 | OTHER | 1286700006 | 01 |   | DMERC REGION 1 | OTHER | 1286700012 | 01 |   | DMERC REGION 1 | OTHER | 1286700013 | 01 |   | DMERC REGION 1 | OTHER | 12867010010 | 01 |   | DMERC REGION 1 | OTHER | 100384530C | 05 | KS |   | MEDICAID | 1286700002 | 01 |   | DMERC REGION 1 | OTHER | 1286700004 | 01 |   | DMERC REGION 1 | OTHER | 1286700005 | 01 |   | DMERC REGION 1 | OTHER |