Provider Demographics
NPI:1538927702
Name:TRUONG, KIMBERLY DIEM
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIEM
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2009
Mailing Address - Country:US
Mailing Address - Phone:562-388-5751
Mailing Address - Fax:
Practice Address - Street 1:429 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2009
Practice Address - Country:US
Practice Address - Phone:562-388-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst