Healthcare Provider Details

I. General information

NPI: 1578856530
Provider Name (Legal Business Name): TAMMY THERESA TRAN-YANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAFAYETTE AVE SE STE 200
GRAND RAPIDS MI
49503-4693
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW MEDICAL ADMINISTRATION
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-6525
  • Fax:
Mailing address:
  • Phone: 616-252-3243
  • Fax: 616-252-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5101019188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: