Healthcare Provider Details

I. General information

NPI: 1609195981
Provider Name (Legal Business Name): JADE CONNIE TRAN M.D.,M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST STE 1617 JOHNS HOPKINS HOSPITAL - TAUSSIG HEART CENTER
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST STE 1617 LOMA LINDA UNIVERSITY HEALTH - INTERNATIONAL HEART INST
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4207
  • Fax: 410-955-0897
Mailing address:
  • Phone: 909-558-4207
  • Fax: 410-955-0897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112503
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberT8182
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA112503
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA112503
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License NumberA112503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: