MEDICARE: MIKE MINH 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	122300000X	Dentist	57236	CA

General Provider Information

NPI Number	:	1649427147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKE MINH TRAN DDS

Provider Business Mailing Address
First Line	:	6685 DOWNEY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-2822
Country	:	US
Telephone Number	:	562-630-4572
Fax Number	:	562-630-1646

Provider Business Practice Location Address
First Line	:	6685 DOWNEY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-2822
Country	:	US
Telephone Number	:	562-630-4572
Fax Number	:	562-630-1646

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	07/23/2010

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