MEDICARE: DUC-TRUNG HUYNH TONG ASW, LAADC(CA)

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	1041C0700X	Clinical Social Worker	135832	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	BIII00231222	CA
3	171M00000X	Case Manager/Care Coordinator		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00	OTHER	CA	00

General Provider Information

NPI Number	:	1578199972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUC-TRUNG HUYNH TONG ASW, LAADC(CA)

Provider Business Mailing Address
First Line	:	1340 TULLY RD STE 304
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3055
Country	:	US
Telephone Number	:	408-271-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 TULLY RD STE 304
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3055
Country	:	US
Telephone Number	:	408-271-3900
Fax Number	:

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

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	12/04/2025

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