Healthcare Provider Details

I. General information

NPI: 1104453604
Provider Name (Legal Business Name): JACQUELINE TRUC-THAO VUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HOSPITAL DR STE 311
MOUNTAIN VIEW CA
94040-4126
US

IV. Provider business mailing address

973 UNIVERSITY AVE
LOS GATOS CA
95032-7636
US

V. Phone/Fax

Practice location:
  • Phone: 650-962-4690
  • Fax: 650-962-4696
Mailing address:
  • Phone: 408-871-3243
  • Fax: 650-448-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA186532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: