MEDICARE: HUEY Q 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	1223E0200X	Endodontics	49453	CA
2	1223E0200X	Endodontics	55928	CA
3	1223G0001X	General Practice Dentistry	54782	CA
4	1223G0001X	General Practice Dentistry	58730	CA
5	1223G0001X	General Practice Dentistry	50727	CA
6	1223P0300X	Periodontics	53739	CA
7	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	55220	CA
8	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	58059	CA
9	1223G0001X	General Practice Dentistry	44371	CA

General Provider Information

NPI Number	:	1578013926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUEY Q TRAN, DDS, INC.

Provider Business Mailing Address
First Line	:	39400 MURRIETA HOT SPRINGS RD
Second Line	:	SUITE 123-B
City	:	MURRIETA
State	:	CA
Zip	:	92563-7707
Country	:	US
Telephone Number	:	951-461-7470
Fax Number	:	951-461-7480

Provider Business Practice Location Address
First Line	:	39400 MURRIETA HOT SPRINGS RD
Second Line	:	SUITE 123-B
City	:	MURRIETA
State	:	CA
Zip	:	92563-7707
Country	:	US
Telephone Number	:	951-461-7470
Fax Number	:	951-461-7480

Authorized Official
Title or Position	:	CEO
Name	:	MR. HUEY Q TRAN
Credential	:	D.D.S.
Telephone Number	:	951-691-3888

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	10/10/2016

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