MEDICARE: DR. XUAN LAN THI PHAN-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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1912107053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XUAN LAN THI PHAN-TRAN DDS

Provider Business Mailing Address
First Line	:	903 S ASHLAND AVE APT 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4096
Country	:	US
Telephone Number	:	312-829-4011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 W ARGYLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3610
Country	:	US
Telephone Number	:	773-271-4431
Fax Number	:

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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