Healthcare Provider Details

I. General information

NPI: 1932383924
Provider Name (Legal Business Name): TOANHUNGTRAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 GEORGETOWN PL C 16
STOCKTON CA
95207-6215
US

IV. Provider business mailing address

4545 GEORGETOWN PL C 16
STOCKTON CA
95207-6215
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-0641
  • Fax: 209-957-0550
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: DR. TOAN HUNG TRAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-957-0641