Healthcare Provider Details

I. General information

NPI: 1558078329
Provider Name (Legal Business Name): NIKOLA QUANG TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W FLORENCE AVE
LOS ANGELES CA
90044-6105
US

IV. Provider business mailing address

3868 1/2 ROSEMEAD BLVD
ROSEMEAD CA
91770-1969
US

V. Phone/Fax

Practice location:
  • Phone: 323-789-5610
  • Fax:
Mailing address:
  • Phone: 626-586-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95112355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: