Provider Demographics
NPI:1629022603
Name:TRAN, DAT DUC (MD)
Entity Type:Individual
Prefix:DR
First Name:DAT
Middle Name:DUC
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 SW WARBLER WAY
Mailing Address - Street 2:APT 102
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9319
Mailing Address - Country:US
Mailing Address - Phone:971-226-2613
Mailing Address - Fax:
Practice Address - Street 1:11820 SW KING JAMES PL
Practice Address - Street 2:SUITE 30
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2480
Practice Address - Country:US
Practice Address - Phone:971-226-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI22102Medicare UPIN