Healthcare Provider Details

I. General information

NPI: 1952057515
Provider Name (Legal Business Name): QUYEN MY TRAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2878 CAMINO DEL RIO S STE 210
SAN DIEGO CA
92108-3845
US

IV. Provider business mailing address

4529 DELTA ST
SAN DIEGO CA
92113-4197
US

V. Phone/Fax

Practice location:
  • Phone: 619-298-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number113484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: