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General NPI Number Information
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NPI Number | 1629065792
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Entity Type | Individual
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Provider Name | DIEM NGOC TRAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 605 E IMPERIAL HWY SUITE C
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City | BREA
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State | CA
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Zip | 92821-5627
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Country | US
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Telephone | 714-460-3489
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Fax | 714-257-1662
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Provider Business Mailing Address
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Address Line | 17588 IVY PLACE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7723
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Country | US
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Telephone | 714-460-3489
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Fax | 714-257-1662
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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 | 12660T
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License Number State | CA
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