Healthcare Provider Details

I. General information

NPI: 1528906682
Provider Name (Legal Business Name): MYDUYEN TRAN DDS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15136 S HARLAN RD
LATHROP CA
95330-9754
US

IV. Provider business mailing address

15136 S HARLAN RD
LATHROP CA
95330-9754
US

V. Phone/Fax

Practice location:
  • Phone: 209-858-4700
  • Fax: 209-858-4704
Mailing address:
  • Phone: 209-858-4700
  • Fax: 209-858-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MYDUYEN TRAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 209-858-4700