Basic Information
| Provider Information | |||||||||
| NPI: | 1619084738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRANG | ||||||||
| FirstName: | LIEM | ||||||||
| MiddleName: | QUANG | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3328 N CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731183428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055245200 | ||||||||
| FaxNumber: | 4055245206 | ||||||||
| Practice Location | |||||||||
| Address1: | 3328 N CLASSEN BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731183428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055245200 | ||||||||
| FaxNumber: | 4055245206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 08/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 3429 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207Q00000X | 3429 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100125970B | 05 | OK | MEDICAID |