Healthcare Provider Details

I. General information

NPI: 1588348544
Provider Name (Legal Business Name): JUSTIN TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N CHERRY ST
TULARE CA
93274-2251
US

IV. Provider business mailing address

PO BOX 580
LEMOORE CA
93245-0580
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-4500
  • Fax:
Mailing address:
  • Phone: 559-386-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: