Healthcare Provider Details

I. General information

NPI: 1801647482
Provider Name (Legal Business Name): THUY QUANG TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MIDLAND PKWY
SUMMERVILLE SC
29485-8104
US

IV. Provider business mailing address

109 BURTON AVE STE A
SUMMERVILLE SC
29485-8117
US

V. Phone/Fax

Practice location:
  • Phone: 843-998-1222
  • Fax:
Mailing address:
  • Phone: 843-998-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: