Provider Demographics
NPI:1467002873
Name:TRAN, SON
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2303
Mailing Address - Country:US
Mailing Address - Phone:614-339-2000
Mailing Address - Fax:740-522-0094
Practice Address - Street 1:1920 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3017
Practice Address - Country:US
Practice Address - Phone:614-339-2000
Practice Address - Fax:740-522-0094
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36004101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist