MEDICARE: PHI TRAN DENTAL CORPORATION

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	1223G0001X	General Practice Dentistry	31721	CA

General Provider Information

NPI Number	:	1528253507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHI TRAN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	844 E VALLEY BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3642
Country	:	US
Telephone Number	:	626-307-1064
Fax Number	:	626-307-5385

Provider Business Practice Location Address
First Line	:	844 E VALLEY BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3642
Country	:	US
Telephone Number	:	626-307-1064
Fax Number	:	626-307-5385

Authorized Official
Title or Position	:	OWNER
Name	:	PHI KIM TRAN
Credential	:	DDS
Telephone Number	:	626-307-1064

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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Directions to “PHI TRAN DENTAL CORPORATION ” Practice Location

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