Provider Demographics
NPI:1285841643
Name:TRAN, LAN THU (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAN
Middle Name:THU
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12152 WUTZKE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1842
Mailing Address - Country:US
Mailing Address - Phone:714-897-3587
Mailing Address - Fax:
Practice Address - Street 1:2150 E SOUTH ST STE 116
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4469
Practice Address - Country:US
Practice Address - Phone:562-531-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice