MEDICARE: DR. KHANH CONG TRAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A68365	CA
2	207R00000X	Internal Medicine Physician	A68365	CA

General Provider Information

NPI Number	:	1124093133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHANH CONG TRAN MD

Provider Business Mailing Address
First Line	:	2611 SENTER RD STE 238
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1186
Country	:	US
Telephone Number	:	408-281-3889
Fax Number	:	408-281-3892

Provider Business Practice Location Address
First Line	:	2611 SENTER RD STE 238
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1186
Country	:	US
Telephone Number	:	408-281-3889
Fax Number	:	408-281-3892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	12/11/2020

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