Healthcare Provider Details

I. General information

NPI: 1649135112
Provider Name (Legal Business Name): TINA TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 ENBORG LN STE 1J018
SAN JOSE CA
95128-2608
US

IV. Provider business mailing address

2312 STANISLAUS CT
SAN JOSE CA
95133-1229
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-6141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: