Provider Demographics
NPI:1902509912
Name:TRAN, MATT (MD)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KP SAN JOSE PSYCHIATRY RESIDENCY
Mailing Address - Street 2:6620 VIA DEL ORO, SECOND FLOOR
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:612-564-9352
Mailing Address - Fax:
Practice Address - Street 1:KP SAN JOSE PSYCHIATRY RESIDENCY
Practice Address - Street 2:6620 VIA DEL ORO, SECOND FLOOR
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:612-564-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program