Basic Information
| Provider Information | |||||||||
| NPI: | 1477642585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | THAO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947043238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815290 | ||||||||
| FaxNumber: | 5109805265 | ||||||||
| Practice Location | |||||||||
| Address1: | 2640 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947043238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815290 | ||||||||
| FaxNumber: | 5109805265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A80749 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.