Healthcare Provider Details

I. General information

NPI: 1588716252
Provider Name (Legal Business Name): KRJ MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 GINGERTREE DR.
ASHTABULA OH
44004
US

IV. Provider business mailing address

PO BOX 376
KINGSVILLE OH
44048
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-9429
  • Fax:
Mailing address:
  • Phone: 440-992-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number35079729
License Number StateOH

VIII. Authorized Official

Name: DR. KHOA DINH TRAN
Title or Position: CEO
Credential: MD
Phone: 440-992-9429