MEDICARE: DR. OANH THI TRAN D.D.S.

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	1223G0001X	General Practice Dentistry	40896	CA

General Provider Information

NPI Number	:	1124134184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OANH THI TRAN D.D.S.

Provider Business Mailing Address
First Line	:	11190 BELLFLOWER AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1759
Country	:	US
Telephone Number	:	714-775-2584
Fax Number	:

Provider Business Practice Location Address
First Line	:	9938 BOLSA AVE
Second Line	:	SUITE 106
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-6039
Country	:	US
Telephone Number	:	714-531-1192
Fax Number	:	714-531-1238

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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