MEDICARE: DR. KHAI GIA TRAN MD

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	208D00000X	General Practice Physician	A52625	CA

General Provider Information

NPI Number	:	1588854509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHAI GIA TRAN MD

Provider Business Mailing Address
First Line	:	19005 WILEYS WELL RD
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-2287
Country	:	US
Telephone Number	:	760-921-3000
Fax Number	:	760-921-7519

Provider Business Practice Location Address
First Line	:	19005 WILEYS WELL RD
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-2287
Country	:	US
Telephone Number	:	760-921-3000
Fax Number	:	760-921-7519

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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