Provider Demographics
NPI:1801992847
Name:TRANVAN, AN (MD)
Entity type:Individual
Prefix:DR
First Name:AN
Middle Name:
Last Name:TRANVAN
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 1:105 N JACKSON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1913
Mailing Address - Country:US
Mailing Address - Phone:408-251-9191
Mailing Address - Fax:408-251-9192
Practice Address - Street 1:105 N JACKSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1913
Practice Address - Country:US
Practice Address - Phone:408-251-9191
Practice Address - Fax:408-251-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82264207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G822640OtherBLUE SHIELD OF CALIFORNIA
CA00G822640Medicaid
CA00G822640OtherBLUE SHIELD OF CALIFORNIA
CA00G822640Medicare ID - Type Unspecified