Provider Demographics
NPI:1801891452
Name:TRUONG, BENJAMIN QUANG (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:QUANG
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 GARVEY AVE
Mailing Address - Street 2:STE I
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-5306
Mailing Address - Country:US
Mailing Address - Phone:626-572-3955
Mailing Address - Fax:626-572-3954
Practice Address - Street 1:9014 GARVEY AVE
Practice Address - Street 2:STE I
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-5306
Practice Address - Country:US
Practice Address - Phone:626-572-3955
Practice Address - Fax:626-572-3954
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48412261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE49434Medicare UPIN