Basic Information
| Provider Information | |||||||||
| NPI: | 1841664711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | KIM | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8581 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | MIDWAY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926551359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149330085 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31581 CANYON ESTATES DR | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925320424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512443500 | ||||||||
| FaxNumber: | 9512443535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2015 | ||||||||
| LastUpdateDate: | 11/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 53000 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.