Healthcare Provider Details

I. General information

NPI: 1891930467
Provider Name (Legal Business Name): CHAU B TRAN D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E MAIN ST STE 102
GRASS VALLEY CA
95945-5724
US

IV. Provider business mailing address

3931 Y ST
SACRAMENTO CA
95817-1422
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-1753
  • Fax:
Mailing address:
  • Phone: 530-887-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: