Provider Demographics
NPI:1336303395
Name:TRAN, HAVEN HAU (LAC)
Entity Type:Individual
Prefix:
First Name:HAVEN
Middle Name:HAU
Last Name:TRAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:HAU
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:517 N. HALLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2112
Mailing Address - Country:US
Mailing Address - Phone:626-676-9261
Mailing Address - Fax:
Practice Address - Street 1:2305 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:S. ELMONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1529
Practice Address - Country:US
Practice Address - Phone:626-676-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12248171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist