Healthcare Provider Details

I. General information

NPI: 1124131065
Provider Name (Legal Business Name): DAN B TRAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 400
LONG BEACH CA
90807-2008
US

IV. Provider business mailing address

4300 LONG BEACH BLVD STE 400
LONG BEACH CA
90807-2008
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7700
  • Fax: 562-591-1311
Mailing address:
  • Phone: 562-591-7700
  • Fax: 562-591-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP12694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13026TPA
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG83738
License Number StateCA

VIII. Authorized Official

Name: MICHELE M STEPP
Title or Position: CREDENTIALING
Credential:
Phone: 714-771-1213