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General NPI Number Information
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NPI Number | 1467994798
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Entity Type | Individual
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Provider Name | PHONG TRAN DDS
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Gender | Male
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 09/25/2021
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Provider Practice Location Address
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Address Line | 4500 ROSEMEAD BLVD STE A
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City | PICO RIVERA
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State | CA
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Zip | 90660-2081
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Country | US
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Telephone | 562-692-9196
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Fax |
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Provider Business Mailing Address
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Address Line | 4522 1/2 ROSEMEAD BLVD
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City | PICO RIVERA
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State | CA
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Zip | 90660-2057
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Country | US
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Telephone | 562-692-9196
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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 | 45624
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License Number State | CA
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