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General NPI Number Information
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NPI Number | 1285621052
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Entity Type | Individual
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Provider Name | TAN D TRAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 1778 WEST 4100 SOUTH
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119
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Country | US
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Telephone | 801-964-8726
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Fax | 801-968-9836
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Provider Business Mailing Address
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Address Line | 1778 WEST 4100 SOUTH
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119
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Country | US
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Telephone | 801-964-8726
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Fax | 801-968-9836
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 52162011205
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License Number State | UT
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