Healthcare Provider Details

I. General information

NPI: 1679991343
Provider Name (Legal Business Name): SEAN TOAN TRUONG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOAN QUANG TRUONG

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BROADWAY
OAKLAND CA
94611-5600
US

IV. Provider business mailing address

2813 LUCENA DR
SAN JOSE CA
95132-2244
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-7847
  • Fax:
Mailing address:
  • Phone: 408-726-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number71258
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number71258
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number71258
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number71258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: