MEDICARE: JACQUELINE TRAN L.AC.

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	171100000X	Acupuncturist	AC3692	CA

General Provider Information

NPI Number	:	1417153016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE TRAN L.AC.

Provider Business Mailing Address
First Line	:	P.O. BOX 611174
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95161
Country	:	US
Telephone Number	:	408-712-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 BERRYESSA RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2903
Country	:	US
Telephone Number	:	408-712-5898
Fax Number	:

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	11/08/2011

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