MEDICARE: TAN, DDS AND 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	1223P0221X	Pediatric Dentistry	53108	CA

General Provider Information

NPI Number	:	1407191810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAN, DDS AND TRAN, DDS, INC

Provider Business Mailing Address
First Line	:	151 S MEDNIK AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1606
Country	:	US
Telephone Number	:	323-263-3303
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	:	323-263-3303
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DR. MINTRA TAN
Credential	:	DDS
Telephone Number	:	323-263-3303

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	06/25/2013

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