Provider Demographics
NPI:1548325855
Name:TRANG, TUNG THANH (MD)
Entity type:Individual
Prefix:
First Name:TUNG
Middle Name:THANH
Last Name:TRANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6309
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93386-6309
Mailing Address - Country:US
Mailing Address - Phone:661-872-3311
Mailing Address - Fax:661-872-3366
Practice Address - Street 1:6501 TRUXTUN AVE.
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0633
Practice Address - Country:US
Practice Address - Phone:661-322-2206
Practice Address - Fax:661-322-7027
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086081207Y00000X
CAA108204207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12960065300OtherBWC
OH2557193Medicaid
OH2557193Medicaid
OHTR7333511Medicare PIN
OHI30090Medicare UPIN