=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447422266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LONG DANG TRAN D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2008
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 N HIGHLAND AVE SUITE F
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-264-1114
-----------------------------------------------------
Fax | 619-264-1111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 N HIGHLAND AVE SUITE F
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-264-1114
-----------------------------------------------------
Fax | 619-264-1111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 51148
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------