Healthcare Provider Details

I. General information

NPI: 1083452775
Provider Name (Legal Business Name): JUDY TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FRANKFORD AVE
PHILADELPHIA PA
19124-3602
US

IV. Provider business mailing address

744 S 6TH ST
PHILADELPHIA PA
19147-2110
US

V. Phone/Fax

Practice location:
  • Phone: 888-296-4742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH075673
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: