Healthcare Provider Details

I. General information

NPI: 1952656084
Provider Name (Legal Business Name): CHAU MONG TRAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA SUITE 200
LAGUNA HILLS CA
92653-7797
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 200
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-5437
  • Fax: 949-951-2715
Mailing address:
  • Phone: 949-951-5437
  • Fax: 949-951-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF0015837-463
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ0193
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: