Healthcare Provider Details

I. General information

NPI: 1720409881
Provider Name (Legal Business Name): HENRY HOANG TRAN, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 S KNOTT AVE
ANAHEIM CA
92804-2807
US

IV. Provider business mailing address

545 S KNOTT AVE
ANAHEIM CA
92804-2807
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-1135
  • Fax: 714-828-1136
Mailing address:
  • Phone: 714-828-1135
  • Fax: 714-828-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number49423
License Number StateCA

VIII. Authorized Official

Name: DR. HENRY H TRAN
Title or Position: DENTIST
Credential: DMD
Phone: 714-828-1135