MEDICARE: LILY TRAN

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1437630027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY TRAN

Provider Business Mailing Address
First Line	:	1880 HALF PENCE WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-1911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 HALF PENCE WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-1911
Country	:	US
Telephone Number	:	408-828-4743
Fax Number	:

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

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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Directions to “ LILY TRAN ” Practice Location

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