MEDICARE: TRACY THUY TRAM VO

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	363A00000X	Physician Assistant		CA

General Provider Information

NPI Number	:	1558966655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY THUY TRAM VO

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	310-248-8511
Fax Number	:	310-248-7396

Provider Business Practice Location Address
First Line	:	6801 PARK TER STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-9212
Country	:	US
Telephone Number	:	310-248-8511
Fax Number	:	310-248-7396

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/16/2025

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