Provider Demographics
NPI:1235150822
Name:TRUONG, HIEN NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:HIEN
Middle Name:NGOC
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 S. KING ROAD SUITE 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1880
Mailing Address - Country:US
Mailing Address - Phone:408-532-0960
Mailing Address - Fax:408-532-0758
Practice Address - Street 1:2593 S KING RD STE 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1880
Practice Address - Country:US
Practice Address - Phone:408-532-0960
Practice Address - Fax:408-532-0758
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770407230OtherTAX I.D NUMBER
CAG17627Medicare UPIN
CA770407230OtherTAX I.D NUMBER