Provider Demographics
NPI:1639366966
Name:HAI TRAN, M.D., INC.
Entity type:Organization
Organization Name:HAI TRAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:HAI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-951-7762
Mailing Address - Street 1:12611 HESPERIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8307
Mailing Address - Country:US
Mailing Address - Phone:760-951-7762
Mailing Address - Fax:760-951-7134
Practice Address - Street 1:12611 HESPERIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8307
Practice Address - Country:US
Practice Address - Phone:760-951-7762
Practice Address - Fax:760-951-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083905207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ07637ZMedicare PIN
CAW18520Medicare PIN