1619967650 NPI number — LUAN CONG TRAN MD MPH

Table of content: LUAN CONG TRAN MD MPH (NPI 1619967650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619967650 NPI number — LUAN CONG TRAN MD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
LUAN
Provider Middle Name:
CONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619967650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1222 S PATTERSON BLVD
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45402-2684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-228-1731
Provider Business Mailing Address Fax Number:
937-228-7827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1222 S PATTERSON BLVD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-228-1731
Provider Business Practice Location Address Fax Number:
937-228-7827
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  35.086919 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3086271 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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