Provider Demographics
NPI:1922484716
Name:TRUONG, JASON
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 S 235TH ST
Mailing Address - Street 2:APT. FF202
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3761
Mailing Address - Country:US
Mailing Address - Phone:503-568-4244
Mailing Address - Fax:
Practice Address - Street 1:10412 264TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8706
Practice Address - Country:US
Practice Address - Phone:253-683-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60562637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
341776OtherNBCOT OTR CERTIFICATION