Provider Demographics
NPI:1265975106
Name:JENNIFER TRAN, M.D., PLLC
Entity type:Organization
Organization Name:JENNIFER TRAN, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MY LINH
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-258-7028
Mailing Address - Street 1:1815 E LAKE MEAD BLVD STE 317
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7193
Mailing Address - Country:US
Mailing Address - Phone:702-960-4150
Mailing Address - Fax:702-960-4154
Practice Address - Street 1:1815 E LAKE MEAD BLVD STE 317
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7193
Practice Address - Country:US
Practice Address - Phone:702-960-4150
Practice Address - Fax:702-960-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-27
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14292207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1427290162OtherINDIVIDUAL NPI
NVV108445Medicare PIN