Provider Demographics
NPI:1760243612
Name:TRAN, THAO LOC HANH (DCM)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:LOC HANH
Last Name:TRAN
Suffix:
Gender:F
Credentials:DCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6250 EXCELSIOR BLVD
Mailing Address - Street 2:STE103
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:763-614-0363
Mailing Address - Fax:
Practice Address - Street 1:IMPACT MASSAGE AND BODYWORKS, ST. LOUIS PARK
Practice Address - Street 2:6250 EXCELSIOR BLVD STE 103
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:763-614-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist