Provider Demographics
NPI:1104941301
Name:TRAN, PHU QUOC (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:PHU
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 ALVIN AVE STE 90
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1664
Mailing Address - Country:US
Mailing Address - Phone:408-528-8698
Mailing Address - Fax:
Practice Address - Street 1:2470 ALVIN AVE STE 90
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1664
Practice Address - Country:US
Practice Address - Phone:408-528-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27552111N00000X
CAAC9623171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0275520Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER