Healthcare Provider Details

I. General information

NPI: 1407766744
Provider Name (Legal Business Name): PHUONG THI MY TRAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S JACKSON ST
SANTA ANA CA
92704-2318
US

IV. Provider business mailing address

925 S JACKSON ST
SANTA ANA CA
92704-2318
US

V. Phone/Fax

Practice location:
  • Phone: 714-933-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07261388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: