Provider Demographics
NPI:1477628519
Name:TRAN, MYHANH T (O,D)
Entity Type:Individual
Prefix:
First Name:MYHANH
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2506
Mailing Address - Country:US
Mailing Address - Phone:310-518-7016
Mailing Address - Fax:310-518-7058
Practice Address - Street 1:1752 E CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2506
Practice Address - Country:US
Practice Address - Phone:310-518-7016
Practice Address - Fax:310-518-7058
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12011T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120110Medicaid
CAU76214Medicare UPIN
CAOP12011Medicare ID - Type Unspecified
CASD0120110Medicaid