Healthcare Provider Details

I. General information

NPI: 1346353646
Provider Name (Legal Business Name): FAWN TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 SW EASTRIDGE ST SUITE 205
PORTLAND OR
97225-5064
US

IV. Provider business mailing address

10200 SW EASTRIDGE ST SUITE 205
PORTLAND OR
97225-5064
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-4555
  • Fax: 503-280-4559
Mailing address:
  • Phone: 503-280-4555
  • Fax: 503-280-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22331
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: