Provider Demographics
NPI:1619405537
Name:TRAN, LILY VU
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:VU
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3820
Mailing Address - Country:US
Mailing Address - Phone:714-489-1533
Mailing Address - Fax:
Practice Address - Street 1:1302 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3820
Practice Address - Country:US
Practice Address - Phone:714-489-1533
Practice Address - Fax:714-489-1533
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant