Healthcare Provider Details

I. General information

NPI: 1164500773
Provider Name (Legal Business Name): TOAN HUNG TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 GEORGETOWN PL C16
STOCKTON CA
95207-6215
US

IV. Provider business mailing address

4545 GEORGETOWN PL STE C16
STOCKTON CA
95207-6230
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-0641
  • Fax:
Mailing address:
  • Phone: 209-957-0641
  • Fax: 209-957-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA37620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: