Provider Demographics
NPI:1063626497
Name:TRAN, THUYET VAN (MD)
Entity type:Individual
Prefix:
First Name:THUYET
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21711 SE HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-9250
Mailing Address - Country:US
Mailing Address - Phone:503-788-6483
Mailing Address - Fax:
Practice Address - Street 1:21711 SE HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-9250
Practice Address - Country:US
Practice Address - Phone:503-788-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500636138Medicaid
ORR165743Medicare PIN