Healthcare Provider Details

I. General information

NPI: 1225010937
Provider Name (Legal Business Name): HUNG TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUNG TRAN M.D.

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OAK ST SE STE 3070
SALEM OR
97301-3975
US

IV. Provider business mailing address

875 OAK ST SE STE 3070
SALEM OR
97301-3975
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-7454
  • Fax: 503-585-9254
Mailing address:
  • Phone: 503-585-7454
  • Fax: 503-585-9254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16732
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: