Healthcare Provider Details

I. General information

NPI: 1780744755
Provider Name (Legal Business Name): ROGER TRAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA SUITE 311
LAGUNA HILLS CA
92653-3144
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 311
LAGUNA HILLS CA
92653-3144
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-2660
  • Fax: 949-305-2036
Mailing address:
  • Phone: 949-305-2660
  • Fax: 949-305-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberA85461
License Number StateCA

VIII. Authorized Official

Name: ROGER TRAN
Title or Position: OWNER AND PHYSICIAN
Credential: MD
Phone: 949-305-2660