=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851965727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIM TRUONG, DO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2021
-----------------------------------------------------
Last Update Date | 05/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 466 E CALAVERAS BLVD STE C
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-5453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-684-3355
-----------------------------------------------------
Fax | 408-684-6663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2929 SILVERLAND CT
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95135-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-684-3355
-----------------------------------------------------
Fax | 408-684-6663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TIM BAOTIN HONG TRUONG
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 408-684-3355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------