=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821286253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH L. TRAN D.M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2007
-----------------------------------------------------
Last Update Date | 05/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1521 W. WHITTIER BLVD.
-----------------------------------------------------
City | LA HABRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-694-4800
-----------------------------------------------------
Fax | 562-694-4880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1521 W. WHITTIER BLVD.
-----------------------------------------------------
City | LA HABRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-694-4800
-----------------------------------------------------
Fax | 562-694-4880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ELIZABETH L TRAN
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 562-943-6699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 49816
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------