Healthcare Provider Details

I. General information

NPI: 1043789514
Provider Name (Legal Business Name): TRAM ANH NGOC DAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

V. Phone/Fax

Practice location:
  • Phone: 408-457-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: