Provider Demographics
NPI:1043318645
Name:TRUONGVINH, ANDY T (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:T
Last Name:TRUONGVINH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21524 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2111
Mailing Address - Country:US
Mailing Address - Phone:510-461-0331
Mailing Address - Fax:510-537-6339
Practice Address - Street 1:21524 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2111
Practice Address - Country:US
Practice Address - Phone:510-461-0331
Practice Address - Fax:510-537-6339
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADCO275540Medicare ID - Type Unspecified
CAU94729Medicare UPIN