1245549369 NPI number — DR. TRANGDAI VUONG HOANG-TRAN O,D.

Table of content: DR. TRANGDAI VUONG HOANG-TRAN O,D. (NPI 1245549369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245549369 NPI number — DR. TRANGDAI VUONG HOANG-TRAN O,D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOANG-TRAN
Provider First Name:
TRANGDAI
Provider Middle Name:
VUONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O,D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOANG
Provider Other First Name:
TRANGDAI
Provider Other Middle Name:
VUONG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245549369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7018-20 N WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60645-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-274-1880
Provider Business Mailing Address Fax Number:
773-274-1881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7018-20 N WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60645-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-895-4799
Provider Business Practice Location Address Fax Number:
847-384-1860
Provider Enumeration Date:
10/07/2010

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: 152W00000X , with the licence number:  046010397 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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