Healthcare Provider Details

I. General information

NPI: 1619153913
Provider Name (Legal Business Name): VUONG VAN TRAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 NE WASCO ST
PORTLAND OR
97213-6737
US

IV. Provider business mailing address

8106 NE WASCO ST
PORTLAND OR
97213-6737
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-8258
  • Fax:
Mailing address:
  • Phone: 503-255-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VUONG VAN TRAN
Title or Position: PRESIDENT
Credential: MD
Phone: 503-255-8258