MEDICARE: DR. NGUYEN NHU TRAN DDS

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	1223P0221X	Pediatric Dentistry	53109	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53109	OTHER	CA	DELTA DENTAL

General Provider Information

NPI Number	:	1053465955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGUYEN NHU TRAN DDS

Provider Business Mailing Address
First Line	:	151 S MEDNIK AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1606
Country	:	US
Telephone Number	:	310-384-0832
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 S MEDNIK AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1606
Country	:	US
Telephone Number	:	310-384-0832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/13/2012

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