Provider Demographics
NPI:1619084738
Name:TRANG, LIEM QUANG (DO)
Entity Type:Individual
Prefix:MR
First Name:LIEM
Middle Name:QUANG
Last Name:TRANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-3428
Mailing Address - Country:US
Mailing Address - Phone:405-524-5200
Mailing Address - Fax:405-524-5206
Practice Address - Street 1:3328 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-3428
Practice Address - Country:US
Practice Address - Phone:405-524-5200
Practice Address - Fax:405-524-5206
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3429207LP2900X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125970BMedicaid
OK100125970BMedicaid