Provider Demographics
NPI:1780007989
Name:PHAT L TRAN DMD INC
Entity Type:Organization
Organization Name:PHAT L TRAN DMD INC
Other - Org Name:PHAT L TRAN DMD, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHAT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-775-7561
Mailing Address - Street 1:14411 BROOKHURST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4667
Mailing Address - Country:US
Mailing Address - Phone:714-775-7561
Mailing Address - Fax:714-775-7550
Practice Address - Street 1:14411 BROOKHURST ST
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4667
Practice Address - Country:US
Practice Address - Phone:714-775-7561
Practice Address - Fax:714-775-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty