Provider Demographics
NPI:1598786147
Name:TRAN, TAM T (CO)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 612103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-2103
Mailing Address - Country:US
Mailing Address - Phone:408-993-0382
Mailing Address - Fax:408-995-6470
Practice Address - Street 1:696 E SANTA CLARA ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1911
Practice Address - Country:US
Practice Address - Phone:408-993-0382
Practice Address - Fax:408-995-6470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4614620001Medicare NSC