Healthcare Provider Details

I. General information

NPI: 1215678586
Provider Name (Legal Business Name): JOSEPH TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE A7D
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

440 GEORGIAN RD
LA CANADA FLINTRIDGE CA
91011-3554
US

V. Phone/Fax

Practice location:
  • Phone: 818-521-1202
  • Fax:
Mailing address:
  • Phone: 818-521-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number190000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: