Basic Information
Provider Information
NPI: 1700053584
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAN
FirstName: HUY
MiddleName: Q
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 INDEPENDENCE PT STE 212
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296154536
CountryCode: US
TelephoneNumber: 8647976308
FaxNumber:  
Practice Location
Address1: 200 PATEWOOD DR STE B350
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296156337
CountryCode: US
TelephoneNumber: 8644544500
FaxNumber: 8644544505
Other Information
ProviderEnumerationDate: 05/12/2008
LastUpdateDate: 03/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD2013-0462NMN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X81982SCY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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