Provider Demographics
NPI:1013013358
Name:TRAN, JUSTICE HUY DUC (MD)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:HUY DUC
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:877-809-5092
Mailing Address - Fax:623-815-9253
Practice Address - Street 1:3400 N DYSART RD
Practice Address - Street 2:BUILDING F, STE 121 & 123
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1003
Practice Address - Country:US
Practice Address - Phone:623-792-8397
Practice Address - Fax:623-544-5187
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33525207V00000X
CAA89473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ939481Medicaid
104754Medicare ID - Type Unspecified
I38555Medicare UPIN