Provider Demographics
NPI:1396752887
Name:TRAN, BANG K (OD)
Entity type:Individual
Prefix:
First Name:BANG
Middle Name:K
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:KALVIN
Other - Middle Name:B
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4713 HILL TOP VIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2708
Mailing Address - Country:US
Mailing Address - Phone:408-238-4900
Mailing Address - Fax:408-238-3903
Practice Address - Street 1:3005 SILVER CREEK RD
Practice Address - Street 2:104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1789
Practice Address - Country:US
Practice Address - Phone:408-238-4900
Practice Address - Fax:408-238-4903
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12009T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB610ZMedicaid
CAU72923Medicare UPIN
CABB610YMedicare PIN