Provider Demographics
NPI:1174629117
Name:AN TRANVAN, MD, INC
Entity Type:Organization
Organization Name:AN TRANVAN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-251-9191
Mailing Address - Street 1:105 N JACKSON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1913
Mailing Address - Country:US
Mailing Address - Phone:408-251-9191
Mailing Address - Fax:408-251-9192
Practice Address - Street 1:105 N JACKSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1913
Practice Address - Country:US
Practice Address - Phone:408-251-9191
Practice Address - Fax:408-251-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82264207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G822640OtherBLUE SHIELD OF CALIFORNIA
CA00G822640Medicaid
CA00G822640Medicare ID - Type Unspecified
CA00G822640Medicaid