Provider Demographics
NPI:1477212124
Name:TRUONG, KIM HOANG (DPT)
Entity Type:Individual
Prefix:DR
First Name:KIM HOANG
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NEWBURY PARK DR APT 343
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1779
Mailing Address - Country:US
Mailing Address - Phone:408-890-1948
Mailing Address - Fax:
Practice Address - Street 1:6155 ALMADEN EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2773
Practice Address - Country:US
Practice Address - Phone:408-268-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist