Organization
JUVENTAS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIEN TRINH MD (CEO)
(650) 888-5728
Entity
Organization
Contact information
Practice address
728 COLLEEN DR, SAN JOSE, CA 95123-4605
(650) 888-5728
Mailing address
728 COLLEEN DR, SAN JOSE, CA 95123-4605
(650) 888-5728
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
193400000X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A891760
—
CA
05
—
00Q796540
—
CA
Enumeration date
11/17/2012
Last updated
11/30/2012
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