Healthcare Provider Details

I. General information

NPI: 1306488010
Provider Name (Legal Business Name): KIMBERLY ANNE TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 SAN IGNACIO AVE STE 150
SAN JOSE CA
95119-1371
US

IV. Provider business mailing address

6203 SAN IGNACIO AVE STE 150
SAN JOSE CA
95119-1371
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9080
  • Fax:
Mailing address:
  • Phone: 408-284-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT155047
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: