Healthcare Provider Details

I. General information

NPI: 1508842337
Provider Name (Legal Business Name): LUAN TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 W CHARLESTON BLVD
LAS VEGAS NV
89102-2179
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-8661
  • Fax: 702-258-1322
Mailing address:
  • Phone: 702-560-2916
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8553
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: