Healthcare Provider Details

I. General information

NPI: 1235048422
Provider Name (Legal Business Name): JENNIFER TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1799 HAMILTON AVE
SAN JOSE CA
95125-5425
US

IV. Provider business mailing address

2369 WALDEN SQ
SAN JOSE CA
95124-1259
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax:
Mailing address:
  • Phone: 408-677-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: