Provider Demographics
NPI:1093763104
Name:TRAN, HAI T (MD)
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:T
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 1:12611 HESPERIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7720
Mailing Address - Country:US
Mailing Address - Phone:760-951-8714
Mailing Address - Fax:760-951-7134
Practice Address - Street 1:12611 HESPERIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7720
Practice Address - Country:US
Practice Address - Phone:760-951-8714
Practice Address - Fax:760-951-7134
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083905207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G839050Medicaid
CAG083905OtherSTATE LICENSE
CAG083905OtherSTATE LICENSE
CAG18652Medicare UPIN
CA00G839050Medicaid
CA00G839052Medicare PIN
00G839050Medicare PIN