Healthcare Provider Details

I. General information

NPI: 1821676594
Provider Name (Legal Business Name): TAM TRUONG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAM TRUONG DO

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

V. Phone/Fax

Practice location:
  • Phone: 209-943-2000
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A20315
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: