Healthcare Provider Details

I. General information

NPI: 1669528089
Provider Name (Legal Business Name): THANH KIEN TRUONG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 BALBOA ST STE B
SAN FRANCISCO CA
94121-2701
US

IV. Provider business mailing address

PO BOX 4067
NAPA CA
94558-0406
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4733
  • Fax: 415-221-4733
Mailing address:
  • Phone: 707-258-4737
  • Fax: 707-258-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number12067T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: