Healthcare Provider Details

I. General information

NPI: 1184149189
Provider Name (Legal Business Name): NGUYEN VINH TOAN TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 E SUMMITRIDGE LN
ORANGE CA
92867-2122
US

IV. Provider business mailing address

3808 E SUMMITRIDGE LN
ORANGE CA
92867-2122
US

V. Phone/Fax

Practice location:
  • Phone: 714-944-8511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME116464
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberME116464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: