Healthcare Provider Details

I. General information

NPI: 1760178347
Provider Name (Legal Business Name): BRYANT QUOC TRAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR STE 2E107
PALM SPRINGS CA
92262-5752
US

IV. Provider business mailing address

1150 N PALM CANYON DR
PALM SPRINGS CA
92262-4402
US

V. Phone/Fax

Practice location:
  • Phone: 760-561-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24516
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: