MEDICARE: DR. TRONG TU 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	41317	CA

General Provider Information

NPI Number	:	1689653966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRONG TU TRAN DDS

Provider Business Mailing Address
First Line	:	88 TULLY ROAD, SUITE 108
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111
Country	:	US
Telephone Number	:	408-270-4849
Fax Number	:	408-270-0105

Provider Business Practice Location Address
First Line	:	88 TULLY ROAD, SUITE 108
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111
Country	:	US
Telephone Number	:	408-270-4849
Fax Number	:	408-270-0105

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/08/2007

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