Provider Demographics
NPI:1790474518
Name:TRAN, VINH QUANG BAO
Entity Type:Individual
Prefix:
First Name:VINH QUANG
Middle Name:BAO
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9582 NEWFAME CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1040
Mailing Address - Country:US
Mailing Address - Phone:714-251-1899
Mailing Address - Fax:
Practice Address - Street 1:8251 WESTMINSTER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3370
Practice Address - Country:US
Practice Address - Phone:714-465-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95222488363LF0000X
CA95025357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily