Provider Demographics
NPI:1053572396
Name:TRAN, PAUL H (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:H
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 1:23823 VALENCIA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2103
Mailing Address - Country:US
Mailing Address - Phone:661-253-2211
Mailing Address - Fax:
Practice Address - Street 1:23823 VALENCIA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2103
Practice Address - Country:US
Practice Address - Phone:661-253-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116017414390200000X
MN534962086S0122X
CAA122353208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
CACB208142Medicare PIN
MN240000377Medicare PIN