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General NPI Number Information
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NPI Number | 1154625960
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Entity Type | Organization
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Legal Business Name | AMY TRAN DDS INC
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 844 E VALLEY BLVD
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3642
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Country | US
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Telephone | 626-307-1064
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Fax | 626-307-5385
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Provider Business Mailing Address
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Address Line | 844 E VALLEY BLVD
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3642
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Country | US
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Telephone | 626-307-1064
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Fax | 626-307-5385
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. AMY TRAN
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Credential | D.D.S.
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Telephone | 626-307-1064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 57683
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License Number State | CA
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