Healthcare Provider Details

I. General information

NPI: 1679809263
Provider Name (Legal Business Name): THAI GIA DIEU TRAN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 04/24/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S EUCLID ST
ANAHEIM CA
92802-1523
US

IV. Provider business mailing address

934 S EUCLID ST
ANAHEIM CA
92802-1523
US

V. Phone/Fax

Practice location:
  • Phone: 714-254-0224
  • Fax: 714-254-0234
Mailing address:
  • Phone: 714-254-0224
  • Fax: 714-254-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20656
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: