Provider Demographics
NPI:1275623159
Name:TRAN, LOC (MD)
Entity Type:Individual
Prefix:DR
First Name:LOC
Middle Name:
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 1:11694 CASTILE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4756
Mailing Address - Country:US
Mailing Address - Phone:323-559-9425
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA696822085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A696820Medicaid
CAWA69682GMedicare PIN
CAAO465TMedicare PIN
CAAP231ZMedicare PIN
CAWA69682HMedicare PIN
CAWA69682CMedicare PIN
CA00A696820Medicare PIN
CAWA69682DMedicare PIN
CAWA69682EMedicare PIN
CAWA69682FMedicare PIN
CA00A696820Medicaid