Healthcare Provider Details

I. General information

NPI: 1366078347
Provider Name (Legal Business Name): JENNIFER ANN TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE ACC-3
BOSTON MA
02118
US

IV. Provider business mailing address

850 HARRISON AVE ACC-3
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4020
  • Fax: 617-414-4028
Mailing address:
  • Phone: 617-414-4020
  • Fax: 617-414-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1018571
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: