Basic Information
| Provider Information | |||||||||
| NPI: | 1003892548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUONG | ||||||||
| FirstName: | KHAI | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420788043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709887256 | ||||||||
| FaxNumber: | 2709883900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 JH OBRYAN AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND RIVERS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420459049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703628246 | ||||||||
| FaxNumber: | 2703629757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39284 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64088784 | 05 | KY | MEDICAID | 65944019 | 05 | KY | MEDICAID | 000000623499 | 01 | KY | ANTHEM BC&BS | OTHER | 7100091610 | 05 | KY | MEDICAID | 000000370768 | 01 | KY | BC/BS | OTHER |