Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G71046 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | G71046 | CA |
NPI | 1184642258 |
---|---|
Provider Name | Peter Truong |
First Address | Glendale, CA 91204-2850 |
Second Address | Montrose, CA 91020-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F53740 | (02) | CA |