Basic Information
| Provider Information | |||||||||
| NPI: | 1235465311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | VIET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5859 W TALAVI BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853061870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022987777 | ||||||||
| FaxNumber: | 6239306060 | ||||||||
| Practice Location | |||||||||
| Address1: | 5859 W TALAVI BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853061870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022987777 | ||||||||
| FaxNumber: | 6239306060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2009 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 59074 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | BP1-0034534 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 59074 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | P1829 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 59074 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 75-2616977-123 | 01 | TX | TRICARE | OTHER | 338331702 | 05 | TX | MEDICAID | 344811YMAF | 01 | TX | MEDICARE | OTHER | P01878866 | 01 | TX | MEDICARE RAIL ROAD | OTHER | Z237031 | 01 | AZ | MEDICARE PTAN | OTHER | 579889 | 05 | AZ | MEDICAID | Z235578 | 01 | AZ | MEDICARE PTAN | OTHER |