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General NPI Number Information
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NPI Number | 1700317294
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Entity Type | Individual
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Provider Name | JIMMY TRAN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 03/25/2017
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Provider Practice Location Address
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Address Line | 5371 HIGHWAY 49 N
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City | MARIPOSA
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State | CA
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Zip | 95338-9503
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Country | US
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Telephone | 209-742-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 12621 STARWOOD DR
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5367
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Country | US
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Telephone | 714-390-9579
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 100894
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License Number State | CA
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