Healthcare Provider Details

I. General information

NPI: 1760660625
Provider Name (Legal Business Name): TIM BAOTIN HONG TRUONG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2008
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 E CALAVERAS BLVD STE C RAINBOW MEDICAL CENTER
MILPITAS CA
95035-5453
US

IV. Provider business mailing address

466 E CALAVERAS BLVD STE C RAINBOW MEDICAL CENTER
MILPITAS CA
95035-5453
US

V. Phone/Fax

Practice location:
  • Phone: 408-684-3355
  • Fax: 408-684-6663
Mailing address:
  • Phone: 408-684-3355
  • Fax: 408-684-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A10857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: