Provider Demographics
NPI:1699952929
Name:TRAN, TAI TIEN (MSPAS, PA-C)
Entity type:Individual
Prefix:MR
First Name:TAI
Middle Name:TIEN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 JOURNEY STE 130
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5330
Mailing Address - Country:US
Mailing Address - Phone:949-360-1069
Mailing Address - Fax:
Practice Address - Street 1:5 JOURNEY STE 130
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5330
Practice Address - Country:US
Practice Address - Phone:949-360-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant