Healthcare Provider Details

I. General information

NPI: 1588980767
Provider Name (Legal Business Name): LISA NGUYEN TRAN DDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 S GLASSELL ST
ORANGE CA
92866-1906
US

IV. Provider business mailing address

436 S GLASSELL ST
ORANGE CA
92866-1906
US

V. Phone/Fax

Practice location:
  • Phone: 714-998-7450
  • Fax: 714-998-2857
Mailing address:
  • Phone: 714-998-7450
  • Fax: 714-998-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number60421
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number143261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: