Healthcare Provider Details

I. General information

NPI: 1164874368
Provider Name (Legal Business Name): HAU VAN TRAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 7TH ST
PLATTE SD
57369-2123
US

IV. Provider business mailing address

315 S OSTEOPATHY AVE
KIRKSVILLE MO
63501-6401
US

V. Phone/Fax

Practice location:
  • Phone: 605-337-1501
  • Fax: 605-337-3360
Mailing address:
  • Phone: 660-785-1000
  • Fax: 660-785-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13667
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR10736
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: