MEDICARE: DR. VINH TAN TRAN MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G62255	CA

General Provider Information

NPI Number	:	1023016375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINH TAN TRAN MD, PHD

Provider Business Mailing Address
First Line	:	1808 VERDUGO BLVD
Second Line	:	SUITE 206
City	:	GLENDALE
State	:	CA
Zip	:	91208-1412
Country	:	US
Telephone Number	:	818-790-7611
Fax Number	:	818-952-5634

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD
Second Line	:	SUITE 206
City	:	GLENDALE
State	:	CA
Zip	:	91208-1412
Country	:	US
Telephone Number	:	818-790-7611
Fax Number	:	818-952-5634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	04/07/2020

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