Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03462 | CA |
N | 222Z00000X | Podiatrist | CPO03462 | CA |
Y | 224P00000X | Prosthetist | CPO03462 | CA |
NPI | 1083980601 |
---|---|
Provider Name | Benjamin Tran |
First Address | Pomona, CA 91767-1926 |
Second Address | Pomona, CA 91767-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 21/04/2016 |