Provider Demographics
NPI:1730230756
Name:TRUONG, DIANE QUYEN (OD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:QUYEN
Last Name:TRUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6561 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6660
Mailing Address - Country:US
Mailing Address - Phone:714-655-1825
Mailing Address - Fax:
Practice Address - Street 1:2800 N MAIN ST
Practice Address - Street 2:MAIN PLACE MALL #104
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6607
Practice Address - Country:US
Practice Address - Phone:714-547-8129
Practice Address - Fax:714-547-5626
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11336Medicare ID - Type Unspecified