Healthcare Provider Details

I. General information

NPI: 1174033807
Provider Name (Legal Business Name): KHOA TRAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 05/07/2024
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W ESPLANADE DR
OXNARD CA
93036-1264
US

IV. Provider business mailing address

620 E JANSS RD
THOUSAND OAKS CA
91360-5113
US

V. Phone/Fax

Practice location:
  • Phone: 805-919-1030
  • Fax:
Mailing address:
  • Phone: 805-495-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6942
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: