Provider Demographics
NPI:1417153016
Name:TRAN, JACQUELINE (LAC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 611174
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161
Mailing Address - Country:US
Mailing Address - Phone:408-712-5898
Mailing Address - Fax:
Practice Address - Street 1:2522 BERRYESSA RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2903
Practice Address - Country:US
Practice Address - Phone:408-712-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist