MEDICARE: DR. CHARLES QUAT 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	43872	CA

General Provider Information

NPI Number	:	1336341064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES QUAT TRAN DDS

Provider Business Mailing Address
First Line	:	1695 ALUM ROCK AVE
Second Line	:	SUITE 6
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2445
Country	:	US
Telephone Number	:	408-937-4757
Fax Number	:	408-937-4758

Provider Business Practice Location Address
First Line	:	1695 ALUM ROCK AVE
Second Line	:	SUITE 6
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2445
Country	:	US
Telephone Number	:	408-937-4757
Fax Number	:	408-937-4758

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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