| St. Paul Medical Clinic A Professional Corporation | |
|
15216 Vanowen St Ste 2a Van Nuys CA 91405-3679 | |
| (818) 989-2406 | |
| (818) 989-0696 |
| Full Name | St. Paul Medical Clinic A Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 15216 Vanowen St Ste 2a, Van Nuys, California |
| Authorized Official Name and Position | Anhtuan Dang Tran (PRESIDENT) |
| Authorized Official Contact | 8189892406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Paul Medical Clinic A Professional Corporation 15216 Vanowen St Ste 2a Van Nuys CA 91405-3679 Ph: (818) 989-2406 | St. Paul Medical Clinic A Professional Corporation 15216 Vanowen St Ste 2a Van Nuys CA 91405-3679 Ph: (818) 989-2406 |
| NPI Number | 1629142062 |
|---|---|
| Provider Enumeration Date | 11/18/2006 |
| Last Update Date | 07/01/2019 |
| Medicare PECOS PAC ID | 6800810094 |
|---|---|
| Medicare Enrollment ID | O20060113000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629142062 | NPI | - | NPPES |
| 00A904280 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A90428 (California) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | A90428 (California) | Secondary |
| Provider Name | Anhtuan D Tran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518961846 PECOS PAC ID: 3870517063 Enrollment ID: I20060114000046 |
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