Healthcare Provider Details

I. General information

NPI: 1427066869
Provider Name (Legal Business Name): KHANH PHUONG TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 4TH AVE STE 100
SAN DIEGO CA
92101-2303
US

IV. Provider business mailing address

2001 4TH AVE STE 100
SAN DIEGO CA
92101-2303
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2600
  • Fax:
Mailing address:
  • Phone: 858-499-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberG83982
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG83982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: