MEDICARE: ROGER 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	1223G0001X	General Practice Dentistry	49874	CA

General Provider Information

NPI Number	:	1578738548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER TRAN DDS INC.

Provider Business Mailing Address
First Line	:	3780 EL CAJON BLVD
Second Line	:	UNIT #1
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1080
Country	:	US
Telephone Number	:	619-265-2467
Fax Number	:	619-265-2196

Provider Business Practice Location Address
First Line	:	3780 EL CAJON BLVD
Second Line	:	UNIT #1
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1080
Country	:	US
Telephone Number	:	619-265-2467
Fax Number	:	619-265-2196

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JUSTENE THUY DOAN
Credential	:	D.D.S.
Telephone Number	:	619-265-2467

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	05/06/2014

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