Basic Information
Provider Information
NPI: 1568183341
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAN
FirstName: THU
MiddleName: B
NamePrefix: MISS
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 33855 JULIET CIR
Address2:  
City: FREMONT
State: CA
PostalCode: 945553453
CountryCode: US
TelephoneNumber: 5109094265
FaxNumber:  
Practice Location
Address1: 213 QUARRY RD
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943041416
CountryCode: US
TelephoneNumber: 6507236469
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/08/2022
LastUpdateDate: 09/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X95020010CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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