Basic Information
| Provider Information | |||||||||
| NPI: | 1548325855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRANG | ||||||||
| FirstName: | TUNG | ||||||||
| MiddleName: | THANH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6309 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933866309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618723311 | ||||||||
| FaxNumber: | 6618723366 | ||||||||
| Practice Location | |||||||||
| Address1: | 6501 TRUXTUN AVE. | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933090633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613222206 | ||||||||
| FaxNumber: | 6613227027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 35086081 | OH | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | A108204 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 12960065300 | 01 | OH | BWC | OTHER | 2557193 | 05 | OH | MEDICAID |