Healthcare Provider Details

I. General information

NPI: 1609646884
Provider Name (Legal Business Name): TRISHA VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 LEXANN AVE STE 206
SAN JOSE CA
95121-1795
US

IV. Provider business mailing address

1569 LEXANN AVE STE 206
SAN JOSE CA
95121-1795
US

V. Phone/Fax

Practice location:
  • Phone: 408-531-8808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: