Healthcare Provider Details

I. General information

NPI: 1932527231
Provider Name (Legal Business Name): VIVIAN MAI-TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TUONG-VI MAI-TRAN

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

1000 10TH AVE # 4B25
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number62459
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: