MEDICARE: DR. TAM-HUONG NGOC TRAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	42434	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-4700829	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1043438773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAM-HUONG NGOC TRAN DDS

Provider Business Mailing Address
First Line	:	11155 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-363-3382
Fax Number	:	818-363-4002

Provider Business Practice Location Address
First Line	:	11155 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-363-3382
Fax Number	:	818-363-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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