Provider Demographics
NPI:1285086686
Name:TRAN, TARRYN THUYTIEN (PA-C)
Entity type:Individual
Prefix:
First Name:TARRYN
Middle Name:THUYTIEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:THUYTIEN
Other - Middle Name:HOANG
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4626 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-9215
Mailing Address - Country:US
Mailing Address - Phone:714-418-9749
Mailing Address - Fax:714-418-1047
Practice Address - Street 1:16543 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2343
Practice Address - Country:US
Practice Address - Phone:714-418-9749
Practice Address - Fax:714-418-1047
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant