Basic Information
| Provider Information | |||||||||
| NPI: | 1346629250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | VAN ANN | ||||||||
| MiddleName: | QUYNH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 W 165TH ST # 96 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123056709 | ||||||||
| FaxNumber: | 2123055523 | ||||||||
| Practice Location | |||||||||
| Address1: | 1855 W TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606127242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129966590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 297166 | NY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 125.066866 | IL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 390200000X | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | 036.156083 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1346629250 | 05 | IL | MEDICAID |