Healthcare Provider Details

I. General information

NPI: 1457614919
Provider Name (Legal Business Name): DONNA TRAN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 OLD NEWPORT BLVD STE 200
NEWPORT BEACH CA
92663-4204
US

IV. Provider business mailing address

16960 BASTANCHURY RD STE I
YORBA LINDA CA
92886-1711
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-7546
  • Fax:
Mailing address:
  • Phone: 714-524-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A13020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: