Healthcare Provider Details

I. General information

NPI: 1225085525
Provider Name (Legal Business Name): EAST JEFFERSON FAMILY PRACTICE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 VETERANS BLVD. SUITE 101
METAIRIE LA
70002
US

IV. Provider business mailing address

PO BOX 54576
NEW ORLEANS LA
70154-4576
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-2505
  • Fax: 504-885-2510
Mailing address:
  • Phone: 504-885-2505
  • Fax: 504-885-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DUNG TRAN
Title or Position: OWNER
Credential: MD
Phone: 504-885-2505