=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316921935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LONG V TRAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 05/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4714 OKEECHOBEE BLVD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33417-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-332-4233
-----------------------------------------------------
Fax | 561-640-7506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2007 PALM BEACH LAKES BLVD
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-420-8555
-----------------------------------------------------
Fax | 561-420-8550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0060439
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------