Provider Demographics
NPI:1457614919
Name:TRAN, DONNA (DO)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16960 BASTANCHURY RD STE I
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1711
Mailing Address - Country:US
Mailing Address - Phone:714-524-9700
Mailing Address - Fax:
Practice Address - Street 1:495 OLD NEWPORT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4204
Practice Address - Country:US
Practice Address - Phone:949-646-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9336432822OtherPECOS