Provider Demographics
NPI:1063639599
Name:TRAN, SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NORIEGA ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4259
Mailing Address - Country:US
Mailing Address - Phone:415-665-9656
Mailing Address - Fax:415-665-9645
Practice Address - Street 1:2323 NORIEGA ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4259
Practice Address - Country:US
Practice Address - Phone:415-665-9656
Practice Address - Fax:415-665-9645
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice