Healthcare Provider Details

I. General information

NPI: 1134039670
Provider Name (Legal Business Name): THAO THI PHUONG TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THALIA TRAN

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 ROCKY MOUNTAIN DR
SAN JOSE CA
95127-4850
US

IV. Provider business mailing address

3320 ROCKY MOUNTAIN DR
SAN JOSE CA
95127-4850
US

V. Phone/Fax

Practice location:
  • Phone: 408-466-8345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number93103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: