MEDICARE: MRS. LILY TU LAN 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	122300000X	Dentist	84180101	CA

General Provider Information

NPI Number	:	1336255041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILY TU LAN TRAN DDS

Provider Business Mailing Address
First Line	:	2126 N TUSTIN AVENUE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705
Country	:	US
Telephone Number	:	714-558-9236
Fax Number	:	714-558-9237

Provider Business Practice Location Address
First Line	:	2126 N TUSTIN AVENUE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705
Country	:	US
Telephone Number	:	714-558-9236
Fax Number	:	714-558-9237

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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