=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972776540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANH CHI TRAN MEDICAL CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2008
-----------------------------------------------------
Last Update Date | 04/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1714 N BUSH ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-8883
-----------------------------------------------------
Fax | 714-541-8882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1714 N BUSH ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92706-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-8883
-----------------------------------------------------
Fax | 714-541-8882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. ANH C TRAN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 714-541-8883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A79019
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------