Provider Demographics
NPI:1912064940
Name:NICK-DUNG M TRAN AND CHARLES E CLEMENT MEDICAL CORP
Entity Type:Organization
Organization Name:NICK-DUNG M TRAN AND CHARLES E CLEMENT MEDICAL CORP
Other - Org Name:YUBA SUTTER MEDICAL CLINIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-671-3201
Mailing Address - Street 1:481 PLUMAS BLVD
Mailing Address - Street 2:202
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5075
Mailing Address - Country:US
Mailing Address - Phone:530-671-3201
Mailing Address - Fax:
Practice Address - Street 1:481 PLUMAS BLVD
Practice Address - Street 2:202
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5075
Practice Address - Country:US
Practice Address - Phone:530-671-3201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA18882Medicare UPIN
CAH87559Medicare UPIN