Active NPI
Khao Dang Truong, O.D.
- Optometrist
- San Diego, CA
National Provider Identifier
1306997333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11967
- Practice address
- 6336 College Grove Way
San Diego, CA 92115-7244 - Phone
- (619) 265-2093
- Fax
- (619) 265-2279
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11967 | CA | Primary |
Addresses
Primary practice location
6336 College Grove Way
San Diego, CA 92115-7244
Mailing address
6336 College Grove Way
San Diego, CA 92115-7244
Phone (619) 265-2093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040228000540 | CA | Practitioner - Optometry | 3678460284 | Practice locations: San Diego, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11967 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1306997333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6336 COLLEGE GROVE WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921157244",
"telephone_number": "619-265-2093",
"fax_number": "619-265-2279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6336 COLLEGE GROVE WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921157244",
"telephone_number": "619-265-2093",
"fax_number": "619-265-2279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUONG",
"first_name": "KHAO",
"middle_name": "DANG",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "11967",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.