Provider Demographics
NPI:1255670113
Name:TRAN, THANH-VAN THI (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:THANH-VAN
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14129 PADDLE WHEEL PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1261
Mailing Address - Country:US
Mailing Address - Phone:405-921-5948
Mailing Address - Fax:
Practice Address - Street 1:5701 N PORTLAND AVE STE 225
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1678
Practice Address - Country:US
Practice Address - Phone:405-600-1210
Practice Address - Fax:405-602-5756
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA2243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant