Provider Demographics
NPI:1093179921
Name:DOMPOR-TRAN, TU-PHUONG THI (MD)
Entity Type:Individual
Prefix:
First Name:TU-PHUONG
Middle Name:THI
Last Name:DOMPOR-TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TU-PHUONG
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7060 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1003
Mailing Address - Country:US
Mailing Address - Phone:619-719-0422
Mailing Address - Fax:
Practice Address - Street 1:7060 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1003
Practice Address - Country:US
Practice Address - Phone:619-719-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA152730207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program