MEDICARE: AARON BRADLEY TRAN

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	DDS105457	CA

General Provider Information

NPI Number	:	1639786817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON BRADLEY TRAN

Provider Business Mailing Address
First Line	:	1535 KENSINGTON RD
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-1927
Country	:	US
Telephone Number	:	626-518-2023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 HUNTINGTON DR
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4520
Country	:	US
Telephone Number	:	626-799-2888
Fax Number	:

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

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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