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General NPI Number Information
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NPI Number | 1912107053
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Entity Type | Individual
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Provider Name | XUAN LAN THI PHAN-TRAN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1140 W ARGYLE ST
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City | CHICAGO
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State | IL
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Zip | 60640-3610
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Country | US
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Telephone | 773-271-4431
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Fax |
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Provider Business Mailing Address
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Address Line | 903 S ASHLAND AVE APT 301
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City | CHICAGO
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State | IL
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Zip | 60607-4096
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Country | US
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Telephone | 312-829-4011
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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 |
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License Number State | IL
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