Healthcare Provider Details

I. General information

NPI: 1952613606
Provider Name (Legal Business Name): THUY THI XUAN TRAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HYDE STREET
SAN FRANCSICO CA
94109
US

IV. Provider business mailing address

900 HYDE STREET
SAN FRANCSICO CA
94109
US

V. Phone/Fax

Practice location:
  • Phone: 619-203-9515
  • Fax:
Mailing address:
  • Phone: 619-203-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A12822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: