MEDICARE: LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION

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	41801	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B4180101	OTHER	CA	CALIFORNIA MEDI-CAL DENTAL PROGRAM

General Provider Information

NPI Number	:	1780826974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION

Provider Business Mailing Address
First Line	:	2126 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7828
Country	:	US
Telephone Number	:	714-558-9236
Fax Number	:	714-558-9237

Provider Business Practice Location Address
First Line	:	2126 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7828
Country	:	US
Telephone Number	:	714-558-9236
Fax Number	:	714-558-9237

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LILY TULAN TRAN
Credential	:	DDS.
Telephone Number	:	714-558-9236

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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