Healthcare Provider Details

I. General information

NPI: 1235150822
Provider Name (Legal Business Name): HIEN NGOC TRUONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2593 S KING RD STE 4
SAN JOSE CA
95122-1880
US

IV. Provider business mailing address

2593 S. KING ROAD SUITE 4
SAN JOSE CA
95122-1880
US

V. Phone/Fax

Practice location:
  • Phone: 408-532-0960
  • Fax: 408-532-0758
Mailing address:
  • Phone: 408-532-0960
  • Fax: 408-532-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: