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General NPI Number Information
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NPI Number | 1366426702
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Entity Type | Individual
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Provider Name | PHUONGANH QUOC TRAN OD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 24300 LAGUNA HILLS MALL
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7601
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Country | US
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Telephone | 949-380-0060
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Fax | 949-203-6366
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Provider Business Mailing Address
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Address Line | 22 WINDCHIME
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City | IRVINE
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State | CA
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Zip | 92603-0635
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Country | US
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Telephone | 714-401-2808
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Fax | 949-203-6366
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12122T
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License Number State | CA
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