Provider Demographics
NPI:1700235983
Name:TRAN, HUONG-THAO THY (MD)
Entity type:Individual
Prefix:DR
First Name:HUONG-THAO
Middle Name:THY
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 JAMES BOHANAN DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2342
Mailing Address - Country:US
Mailing Address - Phone:937-915-6531
Mailing Address - Fax:937-421-8919
Practice Address - Street 1:270 JAMES BOHANAN DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2342
Practice Address - Country:US
Practice Address - Phone:937-915-6531
Practice Address - Fax:937-421-8919
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.39729 LL207Q00000X
OH35.136600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373592Medicaid