Healthcare Provider Details

I. General information

NPI: 1215629209
Provider Name (Legal Business Name): KIMBERLY ISABEL TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOSE FIGUERES AVE STE 255
SAN JOSE CA
95116-1589
US

IV. Provider business mailing address

1545 PROSPERITY CT
SAN JOSE CA
95131-2539
US

V. Phone/Fax

Practice location:
  • Phone: 408-223-7474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: