Basic Information
| Provider Information | |||||||||
| NPI: | 1194949818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | HOANG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10200 TRINITY PKWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952197286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099480808 | ||||||||
| FaxNumber: | 2099571807 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 TRINITY PKWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952197286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099480808 | ||||||||
| FaxNumber: | 2099571807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A101828 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | A101828 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.