Provider Demographics
NPI:1396831459
Name:TRAN, TON DUY (MD)
Entity Type:Individual
Prefix:
First Name:TON
Middle Name:DUY
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 1:6255 UNIVERSITY AVE.
Mailing Address - Street 2:SUITE A2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5727
Mailing Address - Country:US
Mailing Address - Phone:619-583-0553
Mailing Address - Fax:619-583-5702
Practice Address - Street 1:6255 UNIVERSITY AVE.
Practice Address - Street 2:SUITE A2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5727
Practice Address - Country:US
Practice Address - Phone:619-583-0553
Practice Address - Fax:619-583-5702
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36558Medicaid
CAA36558Medicare ID - Type Unspecified
CAA36558Medicaid