Healthcare Provider Details

I. General information

NPI: 1023677366
Provider Name (Legal Business Name): JACQUES TRAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date: 06/11/2019
Reactivation Date: 09/05/2019

III. Provider practice location address

496 KINGS HWY N STE 210
CHERRY HILL NJ
08034-1015
US

IV. Provider business mailing address

496 KINGS HWY N STE 210
CHERRY HILL NJ
08034-1015
US

V. Phone/Fax

Practice location:
  • Phone: 856-667-8222
  • Fax: 856-667-9739
Mailing address:
  • Phone: 856-667-8222
  • Fax: 856-667-9739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00370100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: