Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A104823 | CA |
Y | 208600000X | Surgeon | A104823 | CA |
N | 2082S0105X | Plastic Hand Surgeon | A104823 | CA |
NPI | 1245437581 |
---|---|
Provider Name | Tuan Anh Tran |
First Address | Fountain Valley, CA 92708-3857 |
Second Address | Fountain Valley, CA 92708-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 25/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39 | (02) | CA |
39 | (05) | CA |