Healthcare Provider Details

I. General information

NPI: 1124285424
Provider Name (Legal Business Name): HONG-PHUC THI TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 16TH ST SUITE 204
SANTA MONICA CA
90404-1235
US

IV. Provider business mailing address

1245 16TH ST SUITE 204
SANTA MONICA CA
90404-1235
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4371
  • Fax: 310-319-4141
Mailing address:
  • Phone: 310-319-4371
  • Fax: 310-319-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA106085
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA106085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: