Healthcare Provider Details

I. General information

NPI: 1093327850
Provider Name (Legal Business Name): TRI DUONG RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 12/30/2021
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 INTERNATIONAL CIR
SAN JOSE CA
95119-1130
US

IV. Provider business mailing address

135 HUDSON PL
SAN JOSE CA
95123-4300
US

V. Phone/Fax

Practice location:
  • Phone: 408-363-4827
  • Fax:
Mailing address:
  • Phone: 408-833-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number23869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: