MEDICARE: CALVIN TRIET DOAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A16733	CA

General Provider Information

NPI Number	:	1205364569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALVIN TRIET DOAN DO

Provider Business Mailing Address
First Line	:	2929 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6428
Country	:	US
Telephone Number	:	949-535-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 S HARBOR BLVD
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6428
Country	:	US
Telephone Number	:	949-535-0061
Fax Number	:	714-242-7554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	09/19/2023

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