Healthcare Provider Details

I. General information

NPI: 1184215659
Provider Name (Legal Business Name): DUYEN KY TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 DEL SOL PKWY
DELANO CA
93215-3442
US

IV. Provider business mailing address

1611 1ST ST
BAKERSFIELD CA
93304-2901
US

V. Phone/Fax

Practice location:
  • Phone: 661-720-4011
  • Fax: 661-720-4012
Mailing address:
  • Phone: 661-336-5300
  • Fax: 661-336-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA59249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: