Healthcare Provider Details

I. General information

NPI: 1518126879
Provider Name (Legal Business Name): TIN CHANH TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HOSPITAL RD SUITE A
WHITESBURG KY
41858-7627
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-2255
  • Fax: 606-439-6987
Mailing address:
  • Phone: 859-239-2360
  • Fax: 859-239-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44303
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: