MEDICARE: TRAN, D.D.S., PC

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	46993	CA

General Provider Information

NPI Number	:	1811393598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAN, D.D.S., PC

Provider Business Mailing Address
First Line	:	4365 MEADE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4816
Country	:	US
Telephone Number	:	619-550-1491
Fax Number	:	619-255-5437

Provider Business Practice Location Address
First Line	:	4365 MEADE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4816
Country	:	US
Telephone Number	:	619-550-1491
Fax Number	:	619-255-5437

Authorized Official
Title or Position	:	CEO
Name	:	DR. PAULINE PHUONG TRAN
Credential	:	D.D.S
Telephone Number	:	619-550-1491

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	11/07/2014

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