Basic Information
| Provider Information | |||||||||
| NPI: | 1821076316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | KHOI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 NEWPORT BLVD. | ||||||||
| Address2: | STE 350 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493865260 | ||||||||
| FaxNumber: | 9495150031 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 NEWPORT BLVD | ||||||||
| Address2: | STE 350 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493865260 | ||||||||
| FaxNumber: | 9495150031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD22244 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | A54763 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 288183 | 05 | OR | MEDICAID |