Provider Demographics
NPI:1881668143
Name:TRAN, CUONG (MD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
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:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-877-8600
Mailing Address - Fax:702-369-3361
Practice Address - Street 1:888 S RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3831
Practice Address - Country:US
Practice Address - Phone:702-877-8600
Practice Address - Fax:702-369-3361
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV114678OtherSMA NEW PTAN
NV100500023OtherNVMEDICAID
NV1881668143Medicaid
NV2019664Medicaid
NVVWCHKLOtherNORIDIAN
NV1881668143Medicaid
NVFN760ZMedicare PIN
NVV114678OtherSMA NEW PTAN