Provider Demographics
NPI:1770617722
Name:TUONG, TIEN N
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:N
Last Name:TUONG
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 1:614 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1048
Mailing Address - Country:US
Mailing Address - Phone:408-494-1582
Mailing Address - Fax:408-292-3640
Practice Address - Street 1:614 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1048
Practice Address - Country:US
Practice Address - Phone:408-292-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN950SMedicare PIN
GN950UMedicare PIN
CAGN950WMedicare PIN
CAGN950TMedicare PIN
CAGN950YMedicare PIN
CAGN950ZMedicare PIN
CAGN950RMedicare PIN
CAZZZ03183ZMedicare PIN
CAGN950XMedicare PIN
CAGN950VMedicare PIN