Provider Demographics
NPI:1851965727
Name:TIM TRUONG, DO, INC.
Entity Type:Organization
Organization Name:TIM TRUONG, DO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:BAOTIN HONG
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:408-684-3355
Mailing Address - Street 1:2929 SILVERLAND CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-2021
Mailing Address - Country:US
Mailing Address - Phone:408-684-3355
Mailing Address - Fax:408-684-6663
Practice Address - Street 1:466 E CALAVERAS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5453
Practice Address - Country:US
Practice Address - Phone:408-684-3355
Practice Address - Fax:408-684-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1760660625Medicaid