MEDICARE: TIANA TRUONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	81314	CA

General Provider Information

NPI Number	:	1306484811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA TRUONG

Provider Business Mailing Address
First Line	:	2955 SENTER RD STE 55
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1200
Country	:	US
Telephone Number	:	408-270-6953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 SENTER RD STE 55
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1200
Country	:	US
Telephone Number	:	408-270-6953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	06/16/2020

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Directions to “ TIANA TRUONG ” Practice Location

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