Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G083905 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G083905 | CA |
NPI | 1093763104 |
---|---|
Provider Name | Hai T Tran |
First Address | Victorville, CA 92395-7720 |
Second Address | Victorville, CA 92395-7720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 14/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G839050 | (05) | CA |
G083905 | STATE LICENSE (01) | CA |
G18652 | (02) | CA |