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NPI Code Detail

MEDICARE: MICHELLE MYCHAU TRAN, D.D.S., A PROFESSIONAL DENTAL CORP.

MEDICARE: MICHELLE MYCHAU TRAN, D.D.S., A PROFESSIONAL DENTAL CORP.
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
11223G0001XGeneral Practice Dentistry46225CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780667386
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHELLE MYCHAU TRAN, D.D.S., A PROFESSIONAL DENTAL CORP.
Provider Business Mailing Address
First Line : 12683 BEACH BLVD
Second Line :
City : STANTON
State : CA
Zip : 90680-4007
Country : US
Telephone Number : 714-372-3600
Fax Number : 714-372-3705
Provider Business Practice Location Address
First Line : 12683 BEACH BLVD
Second Line :
City : STANTON
State : CA
Zip : 90680-4007
Country : US
Telephone Number : 714-372-3600
Fax Number : 714-372-3705
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHELLE MYCHAU TRAN
Credential : D.D.S.
Telephone Number : 714-372-3600
Provider Enumeration Date : 11/29/2005
Last Update Date : 08/22/2020

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