Provider Demographics
NPI:1154179570
Name:TRAN, DUC CONG (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DUC
Middle Name:CONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CAMINO DE LOS MARES STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2809
Mailing Address - Country:US
Mailing Address - Phone:949-540-5641
Mailing Address - Fax:
Practice Address - Street 1:9080 IRVINE CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4658
Practice Address - Country:US
Practice Address - Phone:949-540-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist