Healthcare Provider Details

I. General information

NPI: 1508408543
Provider Name (Legal Business Name): HUNG TRAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 RANGER LOOP BLDG 184
HONOLULU HI
96818-5072
US

IV. Provider business mailing address

1897 RANGER LOOP BLDG 184
HONOLULU HI
96818-5072
US

V. Phone/Fax

Practice location:
  • Phone: 630-346-4996
  • Fax:
Mailing address:
  • Phone: 630-346-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: