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General NPI Number Information
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NPI Number | 1205485687
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Entity Type | Individual
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Provider Name | DIANA QUYNH ANH TRAN DDS
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Gender | Female
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 09/08/2019
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Provider Practice Location Address
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Address Line | 3810 LA CRESCENTA AVE
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3914
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Country | US
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Telephone | 818-249-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 15322 SPAR ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-5338
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Country | US
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Telephone | 714-660-8791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 104220
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License Number State | CA
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