Healthcare Provider Details

I. General information

NPI: 1316951577
Provider Name (Legal Business Name): PHILLIP TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 E FIR AVE SUITE 104
FRESNO CA
93720-3808
US

IV. Provider business mailing address

1044 E HERNDON AVE SUITE 108
FRESNO CA
93720-3168
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-5800
  • Fax:
Mailing address:
  • Phone: 559-447-4025
  • Fax: 559-256-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA55091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: