Healthcare Provider Details

I. General information

NPI: 1427290162
Provider Name (Legal Business Name): MY LINH JENNIFER TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E LAKE MEAD BLVD STE 317
N LAS VEGAS NV
89030-7193
US

IV. Provider business mailing address

1815 E LAKE MEAD BLVD STE 317
N LAS VEGAS NV
89030-7193
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-4150
  • Fax: 702-960-4154
Mailing address:
  • Phone: 702-960-4150
  • Fax: 702-960-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14692
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: