MEDICARE: DR. LAN THU TRAN D.M.D.

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	49014	CA

General Provider Information

NPI Number	:	1285841643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAN THU TRAN D.M.D.

Provider Business Mailing Address
First Line	:	12152 WUTZKE ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1842
Country	:	US
Telephone Number	:	714-897-3587
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 E SOUTH ST STE 116
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4469
Country	:	US
Telephone Number	:	562-531-9779
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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