Provider Demographics
NPI:1407989056
Name:HO-TRAN, HUONG MAI (DPT)
Entity Type:Individual
Prefix:
First Name:HUONG
Middle Name:MAI
Last Name:HO-TRAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:HUONG
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:15047 LOS GATOS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2054
Mailing Address - Country:US
Mailing Address - Phone:408-364-6799
Mailing Address - Fax:408-378-4510
Practice Address - Street 1:15047 LOS GATOS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2054
Practice Address - Country:US
Practice Address - Phone:408-364-6799
Practice Address - Fax:408-378-4510
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AT601ZOtherMEDICARE PTAN
CAPT28261OtherMED LICENSE #