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General NPI Number Information
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NPI Number | 1750769840
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Entity Type | Individual
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Provider Name | KHOI TAN NGUYEN TRAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 252 MATLOCK RD STE 130
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City | MANSFIELD
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State | TX
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Zip | 76063-4295
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Country | US
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Telephone | 682-242-8990
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Fax | 682-242-8996
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Provider Business Mailing Address
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Address Line | 252 MATLOCK RD STE 130
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City | MANSFIELD
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State | TX
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Zip | 76063-4295
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Country | US
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Telephone | 682-242-8990
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Fax | 682-242-8996
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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 | U8147
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License Number State | TX
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