Healthcare Provider Details

I. General information

NPI: 1194353177
Provider Name (Legal Business Name): JASON TRAN DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GREENSBORO DR STE 601
MC LEAN VA
22102-3816
US

IV. Provider business mailing address

14602 GEORGE CARTER WAY
CHANTILLY VA
20151-1816
US

V. Phone/Fax

Practice location:
  • Phone: 703-288-4495
  • Fax:
Mailing address:
  • Phone: 985-981-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401419866
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419866
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: