Healthcare Provider Details

I. General information

NPI: 1831113968
Provider Name (Legal Business Name): PHUONG DUC TRAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3862 KATELLA AVE #A
LOS ALAMITOS CA
90720-3354
US

IV. Provider business mailing address

52 SALTON
IRVINE CA
92602-2425
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-5190
  • Fax:
Mailing address:
  • Phone: 949-632-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: