Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G62255 | CA |
NPI | 1023016375 |
---|---|
Provider Name | Dr. Vinh Tan Tran |
First Address | Glendale, CA 91208-1412 |
Second Address | Glendale, CA 91208-1412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 07/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F29603 | (02) |