Healthcare Provider Details

I. General information

NPI: 1699436865
Provider Name (Legal Business Name): TOM QUOC TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4901
US

IV. Provider business mailing address

2713 ELEANOR LN
VIRGINIA BEACH VA
23456-6601
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0688
  • Fax:
Mailing address:
  • Phone: 757-333-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-008865
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: