Healthcare Provider Details

I. General information

NPI: 1679279863
Provider Name (Legal Business Name): LUAN TRAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 N WESTERN AVE
CHICAGO IL
60622-4638
US

IV. Provider business mailing address

1725 N HALSTED ST APT 3
CHICAGO IL
60614-5559
US

V. Phone/Fax

Practice location:
  • Phone: 773-661-0330
  • Fax:
Mailing address:
  • Phone: 949-276-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019035295
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: