Healthcare Provider Details

I. General information

NPI: 1639718513
Provider Name (Legal Business Name): EMILIE TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2019
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date: 05/28/2024
Reactivation Date: 06/10/2024

III. Provider practice location address

6775 GOLDEN GATE DR
DUBLIN CA
94568-4366
US

IV. Provider business mailing address

478 CALERO AVE
SAN JOSE CA
95123-4211
US

V. Phone/Fax

Practice location:
  • Phone: 408-796-8740
  • Fax:
Mailing address:
  • Phone: 408-796-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95448105
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: