Individual provider Active NPI

Lily Vu Tran

  • Physician Assistant
  • Tustin, CA
National Provider Identifier
1619405537
Registry record updated May 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1302 Garland Ave
Tustin, CA 92780-3820
Phone
(714) 489-1533
Fax
(714) 489-1533
NPI assigned
May 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1302 Garland Ave
Tustin, CA 92780-3820

Mailing address

1302 Garland Ave
Tustin, CA 92780-3820
Phone (714) 489-1533

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201008003337 CA Practitioner - Physician Assistant 4082034210 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14443 Culver Dr
14443 A
Irvine, CA 92604-0343
Phone (949) 767-8173

858 N Rose Dr
Suite C 2
Placentia, CA 92870-7522
Phone (714) 792-3736

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54849CAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Carbon Health Medical Group of California PC CurrentSince Sep 21, 2020 Accepting new patients

Locations

2690 5th St
Ste B
Alameda, CA 94501
Phone (510) 439-9447

3195 Harbor Blvd
Ste 3
Costa Mesa, CA 92626
Phone (714) 263-0227

10165 Valley View St
Cypress, CA 90630
Phone (657) 348-2427

14443 Culver Dr
#14443A
Irvine, CA 92604
Phone (949) 767-8173

1040 W Imperial Hwy
Ste D
La Habra, CA 90631
Phone (714) 451-1072

3851 Katella Ave
Ste 100
Los Alamitos, CA 90720
Phone (562) 424-5450

858 N Rose Dr
Ste C2
Placentia, CA 92870
Phone (714) 792-3736

2944 Tapo Canyon Rd
Ste A
Simi Valley, CA 93063
Phone (805) 306-5990

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495584000000",
    "number": "1619405537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 GARLAND AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803820",
            "telephone_number": "714-489-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 GARLAND AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803820",
            "telephone_number": "714-489-1533",
            "fax_number": "714-489-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "LILY",
        "middle_name": "VU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-24",
        "last_updated": "2017-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.