Provider Demographics
NPI:1144779190
Name:TRAN, LONG DANG
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:DANG
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 W SAHARA AVE
Mailing Address - Street 2:SUITE 102.7
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0394
Mailing Address - Country:US
Mailing Address - Phone:702-716-5323
Mailing Address - Fax:
Practice Address - Street 1:5420 W SAHARA AVE
Practice Address - Street 2:SUITE 102.7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0394
Practice Address - Country:US
Practice Address - Phone:702-716-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20161186675Medicaid