Provider Demographics
NPI:1134264831
Name:TRAN, THANH QUOC (MD)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:QUOC
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 1:439 OFARRELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2009
Mailing Address - Country:US
Mailing Address - Phone:415-441-4882
Mailing Address - Fax:
Practice Address - Street 1:439 OFARRELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2009
Practice Address - Country:US
Practice Address - Phone:415-441-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52468207QA0505X, 207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524680Medicaid
CAG16958Medicare UPIN
CA00A524680Medicare ID - Type UnspecifiedPROVIDER NUMBER