Healthcare Provider Details

I. General information

NPI: 1104755321
Provider Name (Legal Business Name): JASON D TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 WILSHIRE BLVD
LOS ANGELES CA
90057-3503
US

IV. Provider business mailing address

11552 BETA AVE
GARDEN GROVE CA
92840-3505
US

V. Phone/Fax

Practice location:
  • Phone: 213-315-5383
  • Fax: 213-315-5384
Mailing address:
  • Phone: 213-315-5383
  • Fax: 213-315-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: