Provider Demographics
NPI:1053750265
Name:TRAN, TONY TOAN NGOC (DO)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:TOAN NGOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:360 E 1ST ST # 567
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3211
Mailing Address - Country:US
Mailing Address - Phone:949-800-8487
Mailing Address - Fax:877-827-6668
Practice Address - Street 1:13075 BLACKBIRD ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2902
Practice Address - Country:US
Practice Address - Phone:714-530-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010203542084P0800X
CA157672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053750265Medicaid