Healthcare Provider Details

I. General information

NPI: 1972843415
Provider Name (Legal Business Name): LIEN-KHUONG PHAM TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 230
RIVERSIDE CA
92505-3312
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 230
RIVERSIDE CA
92505-3312
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3672
  • Fax: 951-781-0365
Mailing address:
  • Phone: 951-781-3672
  • Fax: 951-781-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA182666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberS5795
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberS5795
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA182666
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberS5795
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA182666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: