Provider Demographics
NPI:1811195878
Name:TRANG, PHU III
Entity Type:Individual
Prefix:MR
First Name:PHU
Middle Name:
Last Name:TRANG
Suffix:III
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 1:840 GUADALUPE PKWY
Mailing Address - Street 2:2ND FLR, RM. 238
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-1714
Mailing Address - Country:US
Mailing Address - Phone:408-299-3166
Mailing Address - Fax:408-971-2651
Practice Address - Street 1:840 GUADALUPE PKWY
Practice Address - Street 2:2ND FLR, RM. 238
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1714
Practice Address - Country:US
Practice Address - Phone:408-299-3166
Practice Address - Fax:408-971-2651
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 13640104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker