=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770029811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIANG TUNG TRAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2017
-----------------------------------------------------
Last Update Date | 01/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10161 BOLSA AVE SUITE 209-A
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-6768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-839-7979
-----------------------------------------------------
Fax | 714-839-8686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10161 BOLSA AVE SUITE 209-A
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-6768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-839-7979
-----------------------------------------------------
Fax | 714-839-8686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DDS, MS/ OWNER
-----------------------------------------------------
Name | DR. GIANG TUNG TRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-839-7979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 100096
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------