MEDICARE: HIEN THAI 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	208000000X	Pediatrics Physician	MD2009-0701	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700097458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIEN THAI TRAN MD

Provider Business Mailing Address
First Line	:	4333 PAN AMERICAN FWY NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-6833
Country	:	US
Telephone Number	:	505-266-3835
Fax Number	:	505-266-3340

Provider Business Practice Location Address
First Line	:	4333 PAN AMERICAN FWY NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-6833
Country	:	US
Telephone Number	:	505-266-3835
Fax Number	:	505-266-3340

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/20/2020

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Directions to “ HIEN THAI TRAN MD” Practice Location

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