Healthcare Provider Details

I. General information

NPI: 1013612449
Provider Name (Legal Business Name): VY TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 DANIELS ST
MANTECA CA
95337-6706
US

IV. Provider business mailing address

2288 DANIELS ST
MANTECA CA
95337-6706
US

V. Phone/Fax

Practice location:
  • Phone: 209-456-5610
  • Fax: 415-476-3448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: