Healthcare Provider Details

I. General information

NPI: 1104240928
Provider Name (Legal Business Name): PHUONG QUY TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPE DR
TUSTIN CA
92782-0221
US

IV. Provider business mailing address

14642 NEWPORT AVE STE 300
TUSTIN CA
92780-6059
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-0300
  • Fax: 714-259-1598
Mailing address:
  • Phone: 714-247-0300
  • Fax: 714-259-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA152612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: