Provider Demographics
NPI:1366467102
Name:TRAN, TUAN ANH (DO, DC)
Entity Type:Individual
Prefix:DR
First Name:TUAN
Middle Name:ANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 STORY RD
Mailing Address - Street 2:UNIT 8072
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4603
Mailing Address - Country:US
Mailing Address - Phone:408-263-6207
Mailing Address - Fax:408-263-6245
Practice Address - Street 1:629 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5306
Practice Address - Country:US
Practice Address - Phone:408-263-6207
Practice Address - Fax:408-263-6245
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25815111N00000X
CA20A11925208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258150Medicaid
CA11058739OtherCAQH PROVIDER ID
CA11058739OtherCAQH PROVIDER ID
CADC0258150Medicaid