Healthcare Provider Details

I. General information

NPI: 1568922656
Provider Name (Legal Business Name): JAMES ALEX TRANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 185TH ST W STE 100
LAKEVILLE MN
55044-6696
US

IV. Provider business mailing address

12630 BROOKHURST ST STE D
GARDEN GROVE CA
92840-4800
US

V. Phone/Fax

Practice location:
  • Phone: 612-509-1283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-60174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: