Healthcare Provider Details

I. General information

NPI: 1487851408
Provider Name (Legal Business Name): HIEN THANH TRAN M.D.-PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY SUITE 307
IRVINE CA
92604-4671
US

IV. Provider business mailing address

19271 SIERRA INEZ RD
IRVINE CA
92603-3930
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-1313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number247165
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA104847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: