Provider Demographics
NPI:1689762817
Name:DUC TRAN DO INC
Entity Type:Organization
Organization Name:DUC TRAN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUC
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-531-4646
Mailing Address - Street 1:9559 BOLSA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-531-4616
Mailing Address - Fax:714-531-4617
Practice Address - Street 1:9559 BOLSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-531-4616
Practice Address - Fax:714-531-4617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUC TRAN DO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6642207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20387OtherPTAN GROUP