Healthcare Provider Details

I. General information

NPI: 1932894672
Provider Name (Legal Business Name): JONATHAN V TRUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 S MAIN ST STE 101
CORONA CA
92882-4449
US

IV. Provider business mailing address

1124 S MAIN ST STE 101
CORONA CA
92882-4449
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35547-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: