Healthcare Provider Details

I. General information

NPI: 1497228803
Provider Name (Legal Business Name): THAO THI THANH TRAN-KAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THAO TRAN

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DAVIS ST # 188B
SAN LEANDRO CA
94577-1209
US

IV. Provider business mailing address

237 SUDAN LOOP
PACHECO CA
94553-5249
US

V. Phone/Fax

Practice location:
  • Phone: 510-562-6815
  • Fax:
Mailing address:
  • Phone: 925-917-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: