Basic Information
| Provider Information | |||||||||
| NPI: | 1740202910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUONG | ||||||||
| FirstName: | THAO | ||||||||
| MiddleName: | MING | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 N VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | PORT LAVACA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779793025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615520325 | ||||||||
| FaxNumber: | 3615528759 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 N VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | PORT LAVACA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779793025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615520325 | ||||||||
| FaxNumber: | 3615528759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TXK2128 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | TXK2128 | 01 | TX | TX STATE LICENSE | OTHER |