Healthcare Provider Details

I. General information

NPI: 1952381451
Provider Name (Legal Business Name): KHOA Q TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE SUITE 311
LANSDOWNE VA
20176-8100
US

IV. Provider business mailing address

19455 DEERFIELD AVE SUITE 311
LANSDOWNE VA
20176-8100
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9751
  • Fax:
Mailing address:
  • Phone: 703-723-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101239292
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: