Provider Demographics
NPI:1316444896
Name:TRAN, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TRAN
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 1:1855 ALUM ROCK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1398
Mailing Address - Country:US
Mailing Address - Phone:408-254-7524
Mailing Address - Fax:408-254-7526
Practice Address - Street 1:1855 ALUM ROCK AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1398
Practice Address - Country:US
Practice Address - Phone:408-254-7524
Practice Address - Fax:408-254-7526
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164866207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program