Healthcare Provider Details

I. General information

NPI: 1497269864
Provider Name (Legal Business Name): QUANG DAO TRAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2491 PACIFIC AVE
LONG BEACH CA
90806-2900
US

IV. Provider business mailing address

18104 MESCAL ST
ROWLAND HEIGHTS CA
91748-4312
US

V. Phone/Fax

Practice location:
  • Phone: 562-989-1322
  • Fax:
Mailing address:
  • Phone: 626-200-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: