Healthcare Provider Details

I. General information

NPI: 1013265602
Provider Name (Legal Business Name): NGUYEN AND TRAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 HELLYER AVENUE
SAN JOSE CA
95138
US

IV. Provider business mailing address

6130 HELLYER AVENUE
SAN JOSE CA
95138
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-2647
  • Fax: 408-238-2716
Mailing address:
  • Phone: 408-238-2647
  • Fax: 408-238-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number51778
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMDUNG TRACY TRAN
Title or Position: OWNER
Credential: D.D.S.
Phone: 408-238-2647