Healthcare Provider Details

I. General information

NPI: 1104397538
Provider Name (Legal Business Name): UNION DENTAL GROUP ANAHEIM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 S EUCLID ST STE 100
ANAHEIM CA
92802-1247
US

IV. Provider business mailing address

434 S EUCLID ST STE 100
ANAHEIM CA
92802-1247
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-0900
  • Fax: 714-533-0902
Mailing address:
  • Phone: 714-533-0900
  • Fax: 714-533-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VAL H. TRAN
Title or Position: OWNER
Credential: DDS
Phone: 714-533-0900