Provider Demographics
NPI:1295750784
Name:TRAN, KHANH VAN (MDD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:MDD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:910 SW 38TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7013
Mailing Address - Country:US
Mailing Address - Phone:580-355-7443
Mailing Address - Fax:580-355-7609
Practice Address - Street 1:910 SW 38TH ST
Practice Address - Street 2:STE B
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7013
Practice Address - Country:US
Practice Address - Phone:580-355-7443
Practice Address - Fax:580-355-7609
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKAT128542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E16179Medicare UPIN
$$$$$$$$$Medicare UPIN