Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 7220 | OK |
Y | 213EG0000X | General Practice | 7220 | OK |
NPI | 1003468653 |
---|---|
Provider Name | Phuong Tran |
First Address | Oklahoma City, OK 73142-9716 |
Second Address | Oklahoma City, OK 73142-9716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2019 |
Last Update Date | 19/11/2021 |