1164878773 NPI number — DUONG TRAN N.P.

Table of content: DUONG TRAN N.P. (NPI 1164878773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164878773 NPI number — DUONG TRAN N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
DUONG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164878773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/15/2023
NPI Reactivation Date:
09/21/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10333 EL CAMINO REAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATASCADERO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93422-5808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-468-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 POSADA LN
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
TEMPLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93465-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-542-6700
Provider Business Practice Location Address Fax Number:
805-542-6791
Provider Enumeration Date:
05/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  95004335 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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