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General NPI Number Information
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NPI Number | 1588716252
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Entity Type | Organization
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Legal Business Name | KRJ MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2742 GINGERTREE DR.
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City | ASHTABULA
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State | OH
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Zip | 44004
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Country | US
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Telephone | 440-992-9429
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 376
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City | KINGSVILLE
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State | OH
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Zip | 44048
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Country | US
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Telephone | 440-992-9429
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KHOA DINH TRAN
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Credential | MD
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Telephone | 440-992-9429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 35079729
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License Number State | OH
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