Provider Demographics
NPI:1356477459
Name:TRAN, NINH NGOC (MD)
Entity Type:Individual
Prefix:
First Name:NINH
Middle Name:NGOC
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 1:9772 GARRETT CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3643
Mailing Address - Country:US
Mailing Address - Phone:714-965-9733
Mailing Address - Fax:
Practice Address - Street 1:10840 WARNER AVE STE 107
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3847
Practice Address - Country:US
Practice Address - Phone:714-965-9733
Practice Address - Fax:714-965-9735
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35253170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA352530Medicaid
CAA35253Medicare ID - Type Unspecified
CAA352530Medicaid