Provider Demographics
NPI:1053919142
Name:TRAN, THERESA THANH THUY
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:THANH THUY
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5987
Mailing Address - Country:US
Mailing Address - Phone:949-515-7300
Mailing Address - Fax:
Practice Address - Street 1:1 PARK PLZ STE 600
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5987
Practice Address - Country:US
Practice Address - Phone:949-515-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant