Healthcare Provider Details

I. General information

NPI: 1487832234
Provider Name (Legal Business Name): TONY KHANH TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND RD
SAINT HELENA CA
94574-9554
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-6399
  • Fax: 707-967-5915
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD-17247
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA 107897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: