Healthcare Provider Details

I. General information

NPI: 1043672413
Provider Name (Legal Business Name): DIENHONG TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128
US

IV. Provider business mailing address

3320 MONTGOMERY DR APT 221
SANTA CLARA CA
95054-2930
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-6370
  • Fax:
Mailing address:
  • Phone: 512-825-7696
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberN7357
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number162092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: