Provider Demographics
NPI:1366902439
Name:TRUONG, TAI (MD)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4535
Mailing Address - Country:US
Mailing Address - Phone:714-602-7805
Mailing Address - Fax:714-602-7805
Practice Address - Street 1:500 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4535
Practice Address - Country:US
Practice Address - Phone:714-602-7805
Practice Address - Fax:877-639-3112
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177756207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine