Provider Demographics
NPI:1205873866
Name:TRAN, DUNG (PT)
Entity type:Individual
Prefix:MR
First Name:DUNG
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 HOLT BLVD
Mailing Address - Street 2:A-1
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4837
Mailing Address - Country:US
Mailing Address - Phone:909-626-2220
Mailing Address - Fax:888-218-6160
Practice Address - Street 1:5153 HOLT BLVD
Practice Address - Street 2:A-1
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4837
Practice Address - Country:US
Practice Address - Phone:909-626-2220
Practice Address - Fax:888-218-6160
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC530YMedicare PIN
CABC530ZMedicare PIN