MEDICARE: MISS LAURA FONG TRAN AMT

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	174400000X	Specialist	231038	CA

General Provider Information

NPI Number	:	1720219751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURA FONG TRAN AMT

Provider Business Mailing Address
First Line	:	4162 RICHWOOD AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2228
Country	:	US
Telephone Number	:	760-992-6977
Fax Number	:

Provider Business Practice Location Address
First Line	:	4162 RICHWOOD AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2228
Country	:	US
Telephone Number	:	760-992-6977
Fax Number	:

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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Directions to “ MISS LAURA FONG TRAN AMT” Practice Location

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