Provider Demographics
NPI:1649234949
Name:TRAN, ROGER NGUYEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:NGUYEN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3144
Mailing Address - Country:US
Mailing Address - Phone:949-305-2660
Mailing Address - Fax:949-305-2036
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 311
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3144
Practice Address - Country:US
Practice Address - Phone:949-305-2660
Practice Address - Fax:949-305-2036
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85461207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346286721Medicaid
CABT8896055OtherDEA
CAWA85461BMedicare PIN
CAI12351Medicare UPIN