=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356456461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUONG S VAN MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 SOUTH WASHINGTON ST SUITE #2D
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-548-4300
-----------------------------------------------------
Fax | 703-518-8949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8910 FOOTSTEP COURT
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-548-4300
-----------------------------------------------------
Fax | 703-518-8949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYER
-----------------------------------------------------
Name | TRUONG SON VAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-548-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101030692
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------