Provider Demographics
NPI:1285621052
Name:TRAN, TAN D (MD)
Entity type:Individual
Prefix:DR
First Name:TAN
Middle Name:D
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1778 WEST 4100 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119
Mailing Address - Country:US
Mailing Address - Phone:801-964-8726
Mailing Address - Fax:801-968-9836
Practice Address - Street 1:1778 WEST 4100 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119
Practice Address - Country:US
Practice Address - Phone:801-964-8726
Practice Address - Fax:801-968-9836
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52162011205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH81089Medicare UPIN
UT005741701Medicare ID - Type Unspecified