Provider Demographics
NPI:1669528089
Name:TRUONG, THANH KIEN (OD)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:KIEN
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4067
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0406
Mailing Address - Country:US
Mailing Address - Phone:707-258-4737
Mailing Address - Fax:707-258-4458
Practice Address - Street 1:3443 BALBOA ST STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2701
Practice Address - Country:US
Practice Address - Phone:415-221-4733
Practice Address - Fax:415-221-4733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12067T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation