Provider Demographics
NPI:1023516176
Name:TAN TRAN MD INC
Entity type:Organization
Organization Name:TAN TRAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GI
Authorized Official - Prefix:MR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-855-6908
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-1159
Mailing Address - Country:US
Mailing Address - Phone:714-855-6908
Mailing Address - Fax:209-239-4209
Practice Address - Street 1:292 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4942
Practice Address - Country:US
Practice Address - Phone:209-239-4229
Practice Address - Fax:209-239-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty