Healthcare Provider Details

I. General information

NPI: 1669036208
Provider Name (Legal Business Name): DANIEL VU TRUONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 SE 36TH ST STE 100
MERCER ISLAND WA
98040-3723
US

IV. Provider business mailing address

9675 SE 36TH ST STE 100
MERCER ISLAND WA
98040-3723
US

V. Phone/Fax

Practice location:
  • Phone: 206-275-2122
  • Fax:
Mailing address:
  • Phone: 206-275-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO.OP.61386574
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberDO.OP.61386574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: