Provider Demographics
NPI:1407001167
Name:TRAN, TRANG KHANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:KHANH
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 1:935 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2653
Mailing Address - Country:US
Mailing Address - Phone:415-652-1679
Mailing Address - Fax:
Practice Address - Street 1:3319 MISSION DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-462-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV57781223G0001X
CA582681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice