Individual provider Active NPI

John Dung Tran

  • Family Nurse Practitioner
  • Stockton, CA
National Provider Identifier
1558106872
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95030643 Issued in CA
Practice address
3136 MC Cartney Way
Stockton, CA 95212-1663
Phone
(209) 292-0780
NPI assigned
Jun 27, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95106066 CA
Family Nurse Practitioner 363LF0000X 95030643 CA Primary

Addresses

Primary practice location

3136 MC Cartney Way
Stockton, CA 95212-1663

Mailing address

3136 MC Cartney Way
Stockton, CA 95212-1663
Phone (209) 292-0780

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
95106066CAMDRegistered Nurse
95030643CAMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1558106872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3136 MC CARTNEY WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952121663",
            "telephone_number": "209-292-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3136 MC CARTNEY WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952121663",
            "telephone_number": "209-292-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "JOHN",
        "middle_name": "DUNG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95106066",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95030643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.