Provider Demographics
NPI:1952331415
Name:TRAN, MIMI ANH MAI (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MIMI
Middle Name:ANH MAI
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6131
Mailing Address - Country:US
Mailing Address - Phone:310-689-8568
Mailing Address - Fax:
Practice Address - Street 1:1201 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6131
Practice Address - Country:US
Practice Address - Phone:310-689-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant