Provider Demographics
NPI:1336628502
Name:TRAN, KHANH-NGOC THI (OD)
Entity Type:Individual
Prefix:
First Name:KHANH-NGOC
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5418
Mailing Address - Country:US
Mailing Address - Phone:408-646-7579
Mailing Address - Fax:
Practice Address - Street 1:228 DEL MONTE CTR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6130
Practice Address - Country:US
Practice Address - Phone:831-375-3771
Practice Address - Fax:831-375-1524
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist