Provider Demographics
NPI:1225396138
Name:THE 5TH ELEMENT MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:THE 5TH ELEMENT MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-839-6825
Mailing Address - Street 1:5300 SEQUOIA RD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1283
Mailing Address - Country:US
Mailing Address - Phone:505-839-6825
Mailing Address - Fax:
Practice Address - Street 1:5300 SEQUOIA RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1283
Practice Address - Country:US
Practice Address - Phone:505-839-6825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2008-0787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty