Provider Demographics
NPI:1164500773
Name:TRAN, TOAN HUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:TOAN
Middle Name:HUNG
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 1:4545 GEORGETOWN PL
Mailing Address - Street 2:STE C16
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6230
Mailing Address - Country:US
Mailing Address - Phone:209-957-0641
Mailing Address - Fax:209-957-0550
Practice Address - Street 1:4545 GEORGETOWN PL
Practice Address - Street 2:C16
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6215
Practice Address - Country:US
Practice Address - Phone:209-957-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37620208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A376200Medicaid
CA00A376200Medicare ID - Type Unspecified
CA00A376200Medicaid