Provider Demographics
NPI:1861672727
Name:STRUONG MD CORP.
Entity type:Organization
Organization Name:STRUONG MD CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-866-1807
Mailing Address - Street 1:15568 BROOKHURST ST
Mailing Address - Street 2:SUITE 368
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7572
Mailing Address - Country:US
Mailing Address - Phone:714-866-1807
Mailing Address - Fax:800-809-8379
Practice Address - Street 1:15568 BROOKHURST ST
Practice Address - Street 2:SUITE 368
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7572
Practice Address - Country:US
Practice Address - Phone:714-866-1807
Practice Address - Fax:800-809-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97261261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI64712Medicare UPIN