Healthcare Provider Details

I. General information

NPI: 1679260905
Provider Name (Legal Business Name): THANH TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 HARRIS ST STE D
EUREKA CA
95503-4866
US

IV. Provider business mailing address

2773 HARRIS ST STE D
EUREKA CA
95503-4866
US

V. Phone/Fax

Practice location:
  • Phone: 707-476-2940
  • Fax: 707-443-3356
Mailing address:
  • Phone: 707-476-2940
  • Fax: 707-443-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: