Healthcare Provider Details

I. General information

NPI: 1689666752
Provider Name (Legal Business Name): SOAN TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY STE 205A
IRVINE CA
92604-8649
US

IV. Provider business mailing address

4950 BARRANCA PKWY STE 205A
IRVINE CA
92604-8649
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1212
  • Fax: 949-872-2887
Mailing address:
  • Phone: 949-857-1212
  • Fax: 949-872-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG53613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: