Provider Demographics
NPI:1265498349
Name:TRAN, NICHOLAS THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THANH
Other - Middle Name:Q
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15651 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7556
Mailing Address - Country:US
Mailing Address - Phone:714-531-6969
Mailing Address - Fax:714-531-9698
Practice Address - Street 1:15651 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7556
Practice Address - Country:US
Practice Address - Phone:714-531-6969
Practice Address - Fax:714-531-9698
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67914207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85295Medicare UPIN