Healthcare Provider Details

I. General information

NPI: 1528874997
Provider Name (Legal Business Name): DYLAN VY TRUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EVERETT RD
ALBANY NY
12205-1407
US

IV. Provider business mailing address

343 MADISON AVE
ALBANY NY
12210-1711
US

V. Phone/Fax

Practice location:
  • Phone: 518-701-2085
  • Fax:
Mailing address:
  • Phone: 315-534-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: