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General NPI Number Information
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NPI Number | 1023516176
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Entity Type | Organization
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Legal Business Name | TAN TRAN MD INC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 292 COTTAGE AVE
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City | MANTECA
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State | CA
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Zip | 95336-4942
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Country | US
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Telephone | 209-239-4229
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Fax | 209-239-4209
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Provider Business Mailing Address
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Address Line | PO BOX 2155
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City | MANTECA
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State | CA
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Zip | 95336-1159
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Country | US
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Telephone | 714-855-6908
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Fax | 209-239-4209
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Authorized Official
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Title or Position | GI
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Name | MR. TAN TRAN
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Credential | MD
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Telephone | 714-855-6908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A69009
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License Number State | CA
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