Healthcare Provider Details

I. General information

NPI: 1609442193
Provider Name (Legal Business Name): PHUONG PHI TRAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 S HARBOR BLVD STE D
SANTA ANA CA
92704-2347
US

IV. Provider business mailing address

1103 S HARBOR BLVD STE D
SANTA ANA CA
92704-2347
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-3926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PHUONG TRAN
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 714-839-3926