Provider Demographics
NPI:1477026821
Name:TRAN, HUY DUC
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:DUC
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 N JACKSON AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1804
Mailing Address - Country:US
Mailing Address - Phone:408-666-7624
Mailing Address - Fax:
Practice Address - Street 1:850 S GUILD AVE STE 100A
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3170
Practice Address - Country:US
Practice Address - Phone:209-333-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH80192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH80192OtherBOARD OF PHARMACY