Provider Demographics
NPI:1083869945
Name:TRAN, KRISTINE NGOC (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:NGOC
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 1:9009 MIRA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2738
Mailing Address - Country:US
Mailing Address - Phone:858-530-2898
Mailing Address - Fax:858-530-2978
Practice Address - Street 1:9009 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2738
Practice Address - Country:US
Practice Address - Phone:858-530-2898
Practice Address - Fax:858-530-2978
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist