MEDICARE: VU TRAN DENTAL, INC.

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	54906	CA

General Provider Information

NPI Number	:	1184823536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VU TRAN DENTAL, INC.

Provider Business Mailing Address
First Line	:	2664 BERRYESSA RD
Second Line	:	SUITE 102
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2925
Country	:	US
Telephone Number	:	408-595-4267
Fax Number	:	408-254-0887

Provider Business Practice Location Address
First Line	:	2664 BERRYESSA RD
Second Line	:	SUITE 102
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2925
Country	:	US
Telephone Number	:	408-892-8478
Fax Number	:	408-254-0887

Authorized Official
Title or Position	:	CEO
Name	:	DR. VU TRAN
Credential	:	D.D.S
Telephone Number	:	408-892-8478

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	03/05/2014

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