Individual provider Active NPI

Ngac Tien Tran, M.D.

  • General Practice Physician
  • Stockton, CA
National Provider Identifier
1912001363
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A41161 Issued in CA
Practice address
1545 Saint Marks PLZ
Suite 1C
Stockton, CA 95207-6411
Phone
(209) 473-2833
Fax
(209) 473-0435
NPI assigned
Sep 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A41161 CA Primary

Addresses

Primary practice location

1545 Saint Marks PLZ
Suite 1C
Stockton, CA 95207-6411

Mailing address

1545 Saint Marks PLZ
Suite 1C
Stockton, CA 95207-6411
Phone (209) 473-2833

Other identifiers 1

IdentifierTypeStateIssuer
00A411610MedicaidCA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100809000809 CA Practitioner - General Practice 5092848259 Practice locations: Stockton, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A41161CAMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912001363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 SAINT MARKS PLZ",
            "address_2": "SUITE 1C",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076411",
            "telephone_number": "209-473-2833",
            "fax_number": "209-473-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 SAINT MARKS PLZ",
            "address_2": "SUITE 1C",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076411",
            "telephone_number": "209-473-2833",
            "fax_number": "209-473-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "NGAC",
        "middle_name": "TIEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A41161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A411610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.