MEDICARE: PHA TRAN PA

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1447848247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHA TRAN PA

Provider Business Mailing Address
First Line	:	11161 WOODBURY RD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-3533
Country	:	US
Telephone Number	:	408-646-3190
Fax Number	:

Provider Business Practice Location Address
First Line	:	11161 WOODBURY RD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-3533
Country	:	US
Telephone Number	:	408-646-3190
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	01/06/2021

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Directions to “ PHA TRAN PA” Practice Location

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