Provider Demographics
NPI:1851512271
Name:TRAN & PHAN, A PROFESSIONAL DENTAL COPORATION
Entity Type:Organization
Organization Name:TRAN & PHAN, A PROFESSIONAL DENTAL COPORATION
Other - Org Name:SKY FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-408-2463
Mailing Address - Street 1:8188 SIERRA AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3575
Mailing Address - Country:US
Mailing Address - Phone:909-434-0865
Mailing Address - Fax:
Practice Address - Street 1:8188 SIERRA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3575
Practice Address - Country:US
Practice Address - Phone:909-434-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty