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General NPI Number Information
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NPI Number | 1295194728
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Entity Type | Organization
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Legal Business Name | NGUYENTRAN DDS CORP
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 2001 E 4TH ST STE 102
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City | SANTA ANA
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State | CA
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Zip | 92705-3916
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Country | US
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Telephone | 714-542-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 16027 BROOKHURST ST # I-160
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-1551
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Country | US
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Telephone | 714-542-8888
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. KIET TRAN
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Credential | DDS
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Telephone | 714-542-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 44552
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License Number State | CA
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