Healthcare Provider Details

I. General information

NPI: 1841009974
Provider Name (Legal Business Name): MAIHAN NGOC TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S HIGHLAND ST
MEMPHIS TN
38111-4254
US

IV. Provider business mailing address

5492 KAITLYN DR E
WALLS MS
38680-8510
US

V. Phone/Fax

Practice location:
  • Phone: 901-435-3797
  • Fax:
Mailing address:
  • Phone: 601-455-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13271
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: