Provider Demographics
NPI:1124093133
Name:TRAN, KHANH CONG (MD)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:CONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 SENTER RD STE 238
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1186
Mailing Address - Country:US
Mailing Address - Phone:408-281-3889
Mailing Address - Fax:408-281-3892
Practice Address - Street 1:2611 SENTER RD STE 238
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1186
Practice Address - Country:US
Practice Address - Phone:408-281-3889
Practice Address - Fax:408-281-3892
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68365208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088650Medicaid
ZZZ19769ZMedicare ID - Type Unspecified
G92445Medicare UPIN