Healthcare Provider Details

I. General information

NPI: 1396661534
Provider Name (Legal Business Name): THOMAS TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 TRAUTWEIN RD STE A
RIVERSIDE CA
92508-9474
US

IV. Provider business mailing address

10052 CYNTHIA DR
HUNTINGTON BEACH CA
92646-5439
US

V. Phone/Fax

Practice location:
  • Phone: 951-776-1330
  • Fax:
Mailing address:
  • Phone: 714-723-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: