Healthcare Provider Details

I. General information

NPI: 1821076316
Provider Name (Legal Business Name): KHOI M TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD STE 350
COSTA MESA CA
92627-7745
US

IV. Provider business mailing address

1640 NEWPORT BLVD STE 350
COSTA MESA CA
92627-7745
US

V. Phone/Fax

Practice location:
  • Phone: 949-386-5260
  • Fax: 949-515-0031
Mailing address:
  • Phone: 949-386-5260
  • Fax: 949-515-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD22244
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA54763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: