Provider Demographics
NPI:1225551740
Name:SEDAGHAT, KIEU TU TRAN
Entity Type:Individual
Prefix:MRS
First Name:KIEU
Middle Name:TU TRAN
Last Name:SEDAGHAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1376 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1344
Mailing Address - Country:US
Mailing Address - Phone:510-388-6238
Mailing Address - Fax:
Practice Address - Street 1:911 BERN CT STE 130
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1242
Practice Address - Country:US
Practice Address - Phone:408-437-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11599235Z00000X
CA27081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist