Healthcare Provider Details

I. General information

NPI: 1790829562
Provider Name (Legal Business Name): AMY TRAM ANH TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 PALO VERDE AVE SUITE 101
LONG BEACH CA
90808-4132
US

IV. Provider business mailing address

3325 PALO VERDE AVE SUITE 101
LONG BEACH CA
90808-4132
US

V. Phone/Fax

Practice location:
  • Phone: 562-420-1349
  • Fax: 562-420-9749
Mailing address:
  • Phone: 562-420-1349
  • Fax: 562-420-9749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: