Provider Demographics
NPI:1982675963
Name:TRAN, VINH NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINH
Middle Name:NGOC
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 1:4205 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1213
Mailing Address - Country:US
Mailing Address - Phone:619-280-4861
Mailing Address - Fax:619-280-2043
Practice Address - Street 1:4205 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1213
Practice Address - Country:US
Practice Address - Phone:619-280-4861
Practice Address - Fax:619-280-2043
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982675963Medicaid
CA841616572Medicaid