Healthcare Provider Details

I. General information

NPI: 1306801121
Provider Name (Legal Business Name): VUONG VAN TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/15/2010
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: 503-252-1668
Mailing address:
  • Phone: 503-255-8258
  • Fax: 503-252-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberMD19400
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19400
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: