Provider Demographics
NPI:1619178399
Name:TRAN, MAI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MAI
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21885 HEATHERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2665
Mailing Address - Country:US
Mailing Address - Phone:714-623-2102
Mailing Address - Fax:
Practice Address - Street 1:7761 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4200
Practice Address - Country:US
Practice Address - Phone:714-898-8888
Practice Address - Fax:714-898-8888
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner