Healthcare Provider Details

I. General information

NPI: 1922160050
Provider Name (Legal Business Name): JENNIFER TRANG XA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRANG THI XA D.D.S.

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 MIRA MESA BLVD STE 103
SAN DIEGO CA
92126-4810
US

IV. Provider business mailing address

9225 MIRA MESA BLVD STE 103
SAN DIEGO CA
92126-4810
US

V. Phone/Fax

Practice location:
  • Phone: 858-566-7645
  • Fax: 858-566-6039
Mailing address:
  • Phone: 858-566-7645
  • Fax: 858-566-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number48407
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number48407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: