Healthcare Provider Details

I. General information

NPI: 1639153240
Provider Name (Legal Business Name): HUNG TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12716 NE 36TH ST
SPENCER OK
73084-9103
US

IV. Provider business mailing address

PO BOX 30589
MIDWEST CITY OK
73140-3589
US

V. Phone/Fax

Practice location:
  • Phone: 405-769-3301
  • Fax: 405-769-9685
Mailing address:
  • Phone: 405-769-3301
  • Fax: 405-769-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22503
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: