Provider Demographics
NPI:1053465955
Name:TRAN, NGUYEN NHU (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:NHU
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S MEDNIK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1606
Mailing Address - Country:US
Mailing Address - Phone:310-384-0832
Mailing Address - Fax:
Practice Address - Street 1:151 S MEDNIK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1606
Practice Address - Country:US
Practice Address - Phone:310-384-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53109OtherDELTA DENTAL
CA53109Medicare ID - Type UnspecifiedDENTI-CAL