Healthcare Provider Details

I. General information

NPI: 1619965670
Provider Name (Legal Business Name): DI DAC TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 MONTPELIER DR UNIT 6
SAN JOSE CA
95116-1619
US

IV. Provider business mailing address

2395 MONTPELIER DR UNIT 6
SAN JOSE CA
95116-1619
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-9228
  • Fax: 408-272-0762
Mailing address:
  • Phone: 408-272-9228
  • Fax: 408-272-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: