Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 20A12130 | CA |
NPI | 1003052739 |
---|---|
Provider Name | Ngoc-Tram Gia Tran |
First Address | Long Beach, CA 90807-5606 |
Second Address | Long Beach, CA 90806-1562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2008 |
Last Update Date | 12/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB216845 | (02) | CA |