Provider Demographics
NPI:1760024194
Name:TRAN, BRYAN VINH
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:VINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WATERFRONT WAY APT 403
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3163
Mailing Address - Country:US
Mailing Address - Phone:408-674-6510
Mailing Address - Fax:
Practice Address - Street 1:8101 NE PARKWAY DR STE F2
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-2434
Practice Address - Country:US
Practice Address - Phone:360-882-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE610035871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice