Healthcare Provider Details

I. General information

NPI: 1871756148
Provider Name (Legal Business Name): VINNCENTE TRUONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 STORY RD STE 146
SAN JOSE CA
95122-2112
US

IV. Provider business mailing address

PO BOX K
SAN JOSE CA
95151-0011
US

V. Phone/Fax

Practice location:
  • Phone: 408-392-9028
  • Fax: 408-392-9029
Mailing address:
  • Phone: 408-392-9028
  • Fax: 408-392-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4177
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: