Provider Demographics
NPI:1326110651
Name:TRAN, KHAI ANH (MD)
Entity Type:Individual
Prefix:
First Name:KHAI
Middle Name:ANH
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 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3161 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5234
Practice Address - Country:US
Practice Address - Phone:916-646-8401
Practice Address - Fax:916-736-5533
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000332982085R0202X
CACA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8878583OtherPTAN-CMBC
WA8946140OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WAG8927481OtherPTAN-UAOM
WA0243534OtherLABOR AND INDUSTRIES-CAROL MILGARD BREAST CENTER
WAAB05399OtherMEDICARE PIN TRA KING COUNTY
ORR173668OtherPTAN-PENDLETON, OREGON
WATR7580OtherREGENCE BLUE SHIELD TRA
WA8803387OtherMEDICARE PIN UNION AVENE OPEN
WAG8882926OtherPTAN-MIO1
WA8200511Medicaid
WA8949633OtherLABOR AND INDUSTRIES CRIME VICTIMS-CAROL MILGARD BREAST CENTER
WA8951859OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA0249553OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA120335OtherLABOR AND INDUSTRIES TRA
WA185341OtherLABOR AND INDUSTRIES UNION AVENUE OPEN
WA300095705OtherRR MEDICARE TRA
WATR7252OtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WATR7252OtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WAG8927481OtherPTAN-UAOM