MEDICARE: DR. PAULINE KHONG 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	1223G0001X	General Practice Dentistry	110243	CA

General Provider Information

NPI Number	:	1538907977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULINE KHONG TRAN DDS

Provider Business Mailing Address
First Line	:	6398 CAMDEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2820
Country	:	US
Telephone Number	:	408-601-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 MOORPARK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2030
Country	:	US
Telephone Number	:	408-642-6901
Fax Number	:

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/18/2024

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