Healthcare Provider Details

I. General information

NPI: 1922051739
Provider Name (Legal Business Name): CHARLES M. TRAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 N MOUNTAIN AVE SUITE A
UPLAND CA
91786-8516
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-2228
  • Fax: 909-946-8007
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number20A6999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: