Provider Demographics
NPI:1306801121
Name:TRAN, VUONG VAN (MD)
Entity type:Individual
Prefix:
First Name:VUONG
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 1:8106 NE WASCO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6737
Mailing Address - Country:US
Mailing Address - Phone:503-255-8258
Mailing Address - Fax:503-252-1668
Practice Address - Street 1:8106 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6737
Practice Address - Country:US
Practice Address - Phone:503-255-8258
Practice Address - Fax:503-252-1668
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19400207RA0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080077Medicaid
OR080077Medicaid
ORR115281Medicare PIN