Provider Demographics
NPI:1184981029
Name:LE-TRAN, VIVIAN (DO)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LE-TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1655 N CALIFORNIA BLVD APT 339
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6380 CLARK AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3036
Practice Address - Country:US
Practice Address - Phone:925-875-1677
Practice Address - Fax:925-875-0826
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A13153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program