Provider Demographics
NPI:1649591454
Name:TRAN, MICHAEL NGUYEN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NGUYEN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GRAMERCY UNIT 315
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-0012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 N ROSE DR STE 210
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3800
Practice Address - Country:US
Practice Address - Phone:657-216-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148475207RB0002X, 208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
523359Y5ZMedicare PIN