Provider Demographics
NPI:1780826974
Name:LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION
Entity Type:Organization
Organization Name:LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION
Other - Org Name:TUSTIN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILY
Authorized Official - Middle Name:TULAN
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-558-9236
Mailing Address - Street 1:2126 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7828
Mailing Address - Country:US
Mailing Address - Phone:714-558-9236
Mailing Address - Fax:714-558-9237
Practice Address - Street 1:2126 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7828
Practice Address - Country:US
Practice Address - Phone:714-558-9236
Practice Address - Fax:714-558-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4180101OtherCALIFORNIA MEDI-CAL DENTAL PROGRAM