Healthcare Provider Details

I. General information

NPI: 1457871972
Provider Name (Legal Business Name): JOHNNY TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

1250 WATERS PLACE, TOWER 2
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4316
  • Fax:
Mailing address:
  • Phone: 718-920-4316
  • Fax: 929-263-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number309021-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number309021-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: