Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A52085 | CA |
NPI | 1043285992 |
---|---|
Provider Name | Dr. Louis Tran |
First Address | San Jose, CA 95111-4601 |
Second Address | San Jose, CA 95111-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 30/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F38858 | (02) | |
GR0088650 | (05) | CA |