1326110651 NPI number — KHAI ANH TRAN M.D.

Table of content: SADIYA HUSSEIN HAILLE (NPI 1245026467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326110651 NPI number — KHAI ANH TRAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
KHAI
Provider Middle Name:
ANH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1326110651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10470 OLD PLACERVILLE RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95827-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-470-0071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3161 L ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-646-8401
Provider Business Practice Location Address Fax Number:
916-736-5533
Provider Enumeration Date:
11/14/2006

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: 2085R0202X , with the licence number:  MD00033298 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: CA , 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)

  • Identifier: G8878583 . This is a "PTAN-CMBC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8946140 . This is a "LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8927481 . This is a "PTAN-UAOM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0243534 . This is a "LABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AB05399 . This is a "MEDICARE PIN TRA KING COUNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: R173668 . This is a "PTAN-PENDLETON, OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: TR7580 . This is a "REGENCE BLUE SHIELD TRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8803387 . This is a "MEDICARE PIN UNION AVENE OPEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8882926 . This is a "PTAN-MIO1" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8200511 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8949633 . This is a "LABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8951859 . This is a "LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0249553 . This is a "LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 120335 . This is a "LABOR AND INDUSTRIES TRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 185341 . This is a "LABOR AND INDUSTRIES UNION AVENUE OPEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 300095705 . This is a "RR MEDICARE TRA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: TR7252 . This is a "REGENCE BLUE SHIELD UNION AVENUE OPEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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