Provider Demographics
NPI:1609366459
Name:TRAN, ANH THU THI (DO)
Entity Type:Individual
Prefix:DR
First Name:ANH THU
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N JACKSON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1603
Mailing Address - Country:US
Mailing Address - Phone:408-279-2377
Mailing Address - Fax:408-279-2395
Practice Address - Street 1:227 N JACKSON AVE # 205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1603
Practice Address - Country:US
Practice Address - Phone:408-279-2377
Practice Address - Fax:408-279-2395
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A19010208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program