Healthcare Provider Details

I. General information

NPI: 1124715560
Provider Name (Legal Business Name): EVAN TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S CONGRESS AVE STE 107
AUSTIN TX
78704-1775
US

IV. Provider business mailing address

515 S CONGRESS AVE STE 107
AUSTIN TX
78704-1775
US

V. Phone/Fax

Practice location:
  • Phone: 737-227-3812
  • Fax:
Mailing address:
  • Phone: 737-227-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: