MEDICARE: TIEP M. TRAN DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	49300	CA

General Provider Information

NPI Number	:	1013336866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIEP M. TRAN DDS INC.

Provider Business Mailing Address
First Line	:	12732 BROOKHURST ST
Second Line	:	P.O BOX 0752
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-4810
Country	:	US
Telephone Number	:	714-539-8899
Fax Number	:	714-539-8999

Provider Business Practice Location Address
First Line	:	12732 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-4810
Country	:	US
Telephone Number	:	714-539-8899
Fax Number	:	714-539-8999

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUNG XUAN DINH
Credential	:	D.D.S
Telephone Number	:	714-539-8899

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	07/10/2014

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