Healthcare Provider Details

I. General information

NPI: 1700792496
Provider Name (Legal Business Name): RICHARD TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12131 BROOKHURST ST STE B
GARDEN GROVE CA
92840-2863
US

IV. Provider business mailing address

4610 W MAURIE AVE
SANTA ANA CA
92703-1207
US

V. Phone/Fax

Practice location:
  • Phone: 714-684-8188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: