Provider Demographics
NPI:1841751815
Name:TRAN, MA KOREENA JAYNE YU (PA-C)
Entity type:Individual
Prefix:
First Name:MA KOREENA JAYNE
Middle Name:YU
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3929
Mailing Address - Country:US
Mailing Address - Phone:909-860-1144
Mailing Address - Fax:
Practice Address - Street 1:1514 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3929
Practice Address - Country:US
Practice Address - Phone:909-860-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant