Provider Demographics
NPI:1780434563
Name:MIN-TRAN, DOMINIC MINH
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:MINH
Last Name:MIN-TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOMINIC
Other - Middle Name:MINH
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DRIVE
Mailing Address - Street 2:DEPT. OF MEDICINE, RM. 2B182
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:206-348-9476
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DRIVE
Practice Address - Street 2:DEPT. OF MEDICINE, RM. 2B182
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:206-348-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program