Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 47143 | AZ |
NPI | 1033544564 |
---|---|
Provider Name | Dr. Wayne Truong |
First Address | Mesa, AZ 85202-4768 |
Second Address | Mesa, AZ 85202-4768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2013 |
Last Update Date | 03/10/2019 |