Provider Demographics
NPI:1205595469
Name:TRAN, GARY JOHN (LAC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JOHN
Last Name:TRAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5265 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2202
Mailing Address - Country:US
Mailing Address - Phone:619-376-2176
Mailing Address - Fax:619-323-1693
Practice Address - Street 1:5265 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2202
Practice Address - Country:US
Practice Address - Phone:619-376-2176
Practice Address - Fax:619-323-1693
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist