MEDICARE: TINA QUAN HUE TRAN ND, LAC

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	171100000X	Acupuncturist	AC18436	CA
2	175F00000X	Naturopath	NDF1061	CA

General Provider Information

NPI Number	:	1629620505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA QUAN HUE TRAN ND, LAC

Provider Business Mailing Address
First Line	:	1810 28TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 28TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4221
Country	:	US
Telephone Number	:	415-531-2677
Fax Number	:

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

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/11/2019

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