MEDICARE: HAN QUYNH TRAN

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	107427	CA

General Provider Information

NPI Number	:	1831836477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN QUYNH TRAN

Provider Business Mailing Address
First Line	:	1213 N LAKE AVE UNIT 1
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-3768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 N LAKE AVE UNIT 1
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-3768
Country	:	US
Telephone Number	:	626-584-1800
Fax Number	:

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

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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Directions to “ HAN QUYNH TRAN ” Practice Location

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