Provider Demographics
NPI:1821137142
Name:TRAN, PHUONG LIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LIEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5129 NORTH BROADWAY STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3012
Mailing Address - Country:US
Mailing Address - Phone:773-275-4250
Mailing Address - Fax:773-275-4263
Practice Address - Street 1:5129 NORTH BROADWAY STREET
Practice Address - Street 2:SUITE E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3012
Practice Address - Country:US
Practice Address - Phone:773-275-4250
Practice Address - Fax:773-275-4263
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-089675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine