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General NPI Number Information
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NPI Number | 1215311394
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Entity Type | Organization
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Legal Business Name | MIKE TRAN DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 841 W VALLEY BLVD SUITE# 105
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City | ALHAMBRA
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State | CA
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Zip | 91803-3251
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Country | US
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Telephone | 626-576-1415
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Fax | 626-576-1439
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Provider Business Mailing Address
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Address Line | 841 W VALLEY BLVD SUITE# 105
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City | ALHAMBRA
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State | CA
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Zip | 91803-3251
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Country | US
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Telephone | 626-576-1415
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Fax | 626-576-1439
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIKE M TRAN
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Credential | DDS
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Telephone | 626-576-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 57236
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License Number State | CA
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