Healthcare Provider Details

I. General information

NPI: 1497643233
Provider Name (Legal Business Name): TIMMY TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 E RAMON RD STE 104
PALM SPRINGS CA
92264-1544
US

IV. Provider business mailing address

5001 E RAMON RD STE 104
PALM SPRINGS CA
92264-1544
US

V. Phone/Fax

Practice location:
  • Phone: 760-283-7999
  • Fax:
Mailing address:
  • Phone: 760-283-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113834
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: