Provider Demographics
NPI:1528094596
Name:TRAN, THAO DINH (DO)
Entity type:Individual
Prefix:DR
First Name:THAO
Middle Name:DINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11406 N BAJA PL
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-0126
Mailing Address - Country:US
Mailing Address - Phone:253-318-9039
Mailing Address - Fax:
Practice Address - Street 1:11406 N BAJA PL
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85742-0126
Practice Address - Country:US
Practice Address - Phone:253-318-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001636207L00000X
AZ009400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA141622OtherLNI
WA2136256Medicaid
WA050080927OtherRAILROAD MEDICARE
WA159029600OtherFEDERAL LABOR & INDUSTRY
WA2252TROtherREGENCE BLUESHIELD