Provider Demographics
NPI:1144336090
Name:TRUONG, THONG VAN (DPM)
Entity type:Individual
Prefix:
First Name:THONG
Middle Name:VAN
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 RIO LINDO AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-343-1666
Mailing Address - Fax:530-343-1625
Practice Address - Street 1:670 RIO LINDO AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-343-1666
Practice Address - Fax:530-343-1625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4037213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40370Medicaid
CA000E40370Medicaid
U64940Medicare UPIN