Healthcare Provider Details

I. General information

NPI: 1659686426
Provider Name (Legal Business Name): HUNG D TRAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/22/2010
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number16732
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number16732
License Number StateOR

VIII. Authorized Official

Name: DR. HUNG D TRAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 503-585-7454