Provider Demographics
NPI:1396253878
Name:TRAN, DAI NGOCQUOC (PHARMD)
Entity type:Individual
Prefix:
First Name:DAI
Middle Name:NGOCQUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 NIGHTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7652
Mailing Address - Country:US
Mailing Address - Phone:408-387-3490
Mailing Address - Fax:
Practice Address - Street 1:7150 CAMINO ARROYO
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7351
Practice Address - Country:US
Practice Address - Phone:408-848-8171
Practice Address - Fax:408-848-5832
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH76513183500000X
MN122675183500000X
TX60202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist