Provider Demographics
NPI:1750632253
Name:TRAN, EVANS PHUNG (PA)
Entity Type:Individual
Prefix:MS
First Name:EVANS
Middle Name:PHUNG
Last Name:TRAN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-594-0860
Mailing Address - Fax:562-594-9010
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-594-0860
Practice Address - Fax:562-594-9010
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-03-13
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Provider Licenses
StateLicense IDTaxonomies
CA1106874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant