Provider Demographics
NPI:1992057368
Name:TRAN, TUAN QUANG
Entity type:Individual
Prefix:MR
First Name:TUAN
Middle Name:QUANG
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2915
Mailing Address - Country:US
Mailing Address - Phone:617-288-8199
Mailing Address - Fax:617-288-8191
Practice Address - Street 1:1435 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2915
Practice Address - Country:US
Practice Address - Phone:617-288-8199
Practice Address - Fax:617-288-8191
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH20856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist