Healthcare Provider Details

I. General information

NPI: 1912571829
Provider Name (Legal Business Name): DIANA THAO VI TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MILPITAS BLVD
MILPITAS CA
95035-4499
US

IV. Provider business mailing address

100 N MILPITAS BLVD
MILPITAS CA
95035-4499
US

V. Phone/Fax

Practice location:
  • Phone: 800-478-8837
  • Fax:
Mailing address:
  • Phone: 408-720-6610
  • Fax: 510-679-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125079548
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA195892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: