Provider Demographics
NPI:1124248885
Name:TRAN, TIEN (CP, LO, FAAOP)
Entity type:Individual
Prefix:MR
First Name:TIEN
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:CP, LO, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 WALNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3110
Mailing Address - Country:US
Mailing Address - Phone:901-737-5738
Mailing Address - Fax:901-737-5692
Practice Address - Street 1:748 WALNUT KNOLL LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3110
Practice Address - Country:US
Practice Address - Phone:901-737-5738
Practice Address - Fax:901-737-5692
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000180222Z00000X
TNPRO0000000084224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist