=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003828583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAN B TRAN MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 07/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 363 S MAIN ST STE 325
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-771-1213
-----------------------------------------------------
Fax | 714-771-7126
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4300 LONG BEACH BLVD STE 400
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90807-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-591-7700
-----------------------------------------------------
Fax | 561-591-1311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACTING
-----------------------------------------------------
Name | MICHELE M STEPP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-771-1213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G83738
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------