Provider Demographics
NPI:1801821426
Name:CHUTUOC C. TRANDINH, M.D., L.L.C.
Entity Type:Organization
Organization Name:CHUTUOC C. TRANDINH, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-479-7791
Mailing Address - Street 1:PO BOX 2164
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97528-0270
Mailing Address - Country:US
Mailing Address - Phone:541-479-7791
Mailing Address - Fax:541-479-8515
Practice Address - Street 1:124 NW MIDLAND AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1269
Practice Address - Country:US
Practice Address - Phone:541-479-7791
Practice Address - Fax:541-479-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R117164Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N