Healthcare Provider Details

I. General information

NPI: 1255539326
Provider Name (Legal Business Name): NHA PHONG TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 K STREET SUITE 502
SACRAMENTO CA
95816-5119
US

IV. Provider business mailing address

511 GRANGER TER APT 2
SUNNYVALE CA
94087-4515
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-4400
  • Fax:
Mailing address:
  • Phone: 714-331-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL1815
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA106513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: