Healthcare Provider Details

I. General information

NPI: 1942830385
Provider Name (Legal Business Name): VI THUY TRAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16501 PACIFIC COAST HWY
SUNSET BEACH CA
90742
US

IV. Provider business mailing address

1926 PINE ST
HUNTINGTON BEACH CA
92648-2761
US

V. Phone/Fax

Practice location:
  • Phone: 562-592-5100
  • Fax:
Mailing address:
  • Phone: 714-867-4896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95053168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: