Healthcare Provider Details

I. General information

NPI: 1003311614
Provider Name (Legal Business Name): ALEXANDRIA TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S COTTONWOOD ST STE 650
SALT LAKE CITY UT
84107-5716
US

IV. Provider business mailing address

5171 S COTTONWOOD ST STE 650
SALT LAKE CITY UT
84107-5716
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9600
  • Fax:
Mailing address:
  • Phone: 801-507-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11414375-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036164802
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number036.164802
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: