Healthcare Provider Details

I. General information

NPI: 1518657394
Provider Name (Legal Business Name): THAO THI THU TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 ARTESIA BLVD
BELLFLOWER CA
90706-6719
US

IV. Provider business mailing address

10592 LA DONA DR
GARDEN GROVE CA
92840-1636
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-8681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95026567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF05230263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: