Provider Demographics
NPI:1528101847
Name:THANH N TRAN A PROF CORP
Entity type:Organization
Organization Name:THANH N TRAN A PROF CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-564-5805
Mailing Address - Street 1:8426 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280
Mailing Address - Country:US
Mailing Address - Phone:323-564-5805
Mailing Address - Fax:323-564-1670
Practice Address - Street 1:8426 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280
Practice Address - Country:US
Practice Address - Phone:323-564-5805
Practice Address - Fax:323-564-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7502207Q00000X
CAA75777207Q00000X
CAA40326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GR0055100OtherMEDICAL PROVIDER GROUP
CA00A403260Medicaid
CAA40326Medicare ID - Type Unspecified
CA00A403260Medicaid