Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A106085 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A106085 | CA |
NPI | 1124285424 |
---|---|
Provider Name | Hong-Phuc Thi Tran |
First Address | Santa Monica, CA 90404-1235 |
Second Address | Santa Monica, CA 90404-1235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124285424 | (05) | CA |