Healthcare Provider Details

I. General information

NPI: 1184537664
Provider Name (Legal Business Name): TAN THANG TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD SPC 235
AIEA HI
96701-4707
US

IV. Provider business mailing address

98-1005 MOANALUA RD SPC 235
AIEA HI
96701-4707
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-8588
  • Fax: 808-556-3389
Mailing address:
  • Phone: 808-488-8588
  • Fax: 808-556-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number988
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: