Healthcare Provider Details

I. General information

NPI: 1447296363
Provider Name (Legal Business Name): ACADEMY SKIN PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR SUITE 210
SAN DIEGO CA
92121-3021
US

IV. Provider business mailing address

4510 EXECUTIVE DR SUITE 210
SAN DIEGO CA
92121-3021
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-1430
  • Fax: 858-452-0651
Mailing address:
  • Phone: 858-452-1430
  • Fax: 858-452-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA68200
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA65177
License Number StateCA

VIII. Authorized Official

Name: DR. ALIZABETH LECHI TRUONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-452-1430