Healthcare Provider Details

I. General information

NPI: 1609956838
Provider Name (Legal Business Name): TUYEN T TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3439 BUCKHORN DR SUITE 100
LEXINGTON KY
40515-1716
US

IV. Provider business mailing address

216 COLONIAL DR
VERSAILLES KY
40383-9387
US

V. Phone/Fax

Practice location:
  • Phone: 859-368-9874
  • Fax:
Mailing address:
  • Phone: 859-368-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34583-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number40429
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: