Provider Demographics
NPI:1023677366
Name:TRAN, JACQUES (DPM)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 KINGS HWY N STE 210
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1015
Mailing Address - Country:US
Mailing Address - Phone:856-667-8222
Mailing Address - Fax:856-667-9739
Practice Address - Street 1:496 KINGS HWY N STE 210
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1015
Practice Address - Country:US
Practice Address - Phone:856-667-8222
Practice Address - Fax:856-667-9739
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-08-29
Deactivation Date:2019-06-11
Deactivation Code:
Reactivation Date:2019-09-05
Provider Licenses
StateLicense IDTaxonomies
NJ0207XX0004X
390200000X
NJ25MD00370100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program