Provider Demographics
NPI:1831113968
Name:TRAN, PHUONG DUC (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:DUC
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SALTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2425
Mailing Address - Country:US
Mailing Address - Phone:949-632-4591
Mailing Address - Fax:
Practice Address - Street 1:3862 KATELLA AVE
Practice Address - Street 2:#A
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3354
Practice Address - Country:US
Practice Address - Phone:562-795-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice