Basic Information
| Provider Information | |||||||||
| NPI: | 1649234949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | NGUYEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23521 PASEO DE VALENCIA | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493052660 | ||||||||
| FaxNumber: | 9493052036 | ||||||||
| Practice Location | |||||||||
| Address1: | 23521 PASEO DE VALENCIA STE 311 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493052660 | ||||||||
| FaxNumber: | 9493052036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | A85461 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1346286721 | 05 | CA | MEDICAID |