Provider Demographics
NPI:1538696778
Name:TRAN, DERRICK (MD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
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 1:1400 REYNOLDS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5562
Mailing Address - Country:US
Mailing Address - Phone:949-387-4724
Mailing Address - Fax:
Practice Address - Street 1:1400 REYNOLDS AVE STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5562
Practice Address - Country:US
Practice Address - Phone:949-387-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33110390200000X, 2085R0204X
FLME1618122085R0204X
CAA1902322085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program