Provider Demographics
NPI:1093387136
Name:TRAN, JIM NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 ALLENFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5100
Mailing Address - Country:US
Mailing Address - Phone:702-475-0561
Mailing Address - Fax:
Practice Address - Street 1:7175 W LAKE MEAD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1303
Practice Address - Country:US
Practice Address - Phone:702-228-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist