MEDICARE: VY-VAN TRAN PA-C

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	PA22558	CA

General Provider Information

NPI Number	:	1891046330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VY-VAN TRAN PA-C

Provider Business Mailing Address
First Line	:	1212 S BRISTOL ST STE 16
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 S BRISTOL ST STE 16
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3439
Country	:	US
Telephone Number	:	714-966-0646
Fax Number	:

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

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	04/07/2020

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Directions to “ VY-VAN TRAN PA-C” Practice Location

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