Provider Demographics
NPI:1891817805
Name:TRUONG, TIFFANY THUY (OD, FIAOMC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:THUY
Last Name:TRUONG
Suffix:
Gender:F
Credentials:OD, FIAOMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1057
Mailing Address - Country:US
Mailing Address - Phone:510-440-9825
Mailing Address - Fax:510-250-1065
Practice Address - Street 1:5395 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1057
Practice Address - Country:US
Practice Address - Phone:510-440-9825
Practice Address - Fax:510-250-1065
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9442 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094420Medicaid
CASD0094420Medicare ID - Type Unspecified
CASD0094420Medicaid