Provider Demographics
NPI:1851461081
Name:TRAN, CAROL (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 VALLEY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1919
Mailing Address - Country:US
Mailing Address - Phone:626-573-8826
Mailing Address - Fax:626-573-8861
Practice Address - Street 1:9105 VALLEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1919
Practice Address - Country:US
Practice Address - Phone:626-573-8826
Practice Address - Fax:626-573-8861
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051985302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAJNGUYENOtherPA
CAP057OtherPHW
CACTRANOtherAPC
CAA51985Medicaid
CAA51985-POtherPIPA
CAA51985-POtherPIPA