Provider Demographics
NPI:1134344294
Name:TRAN, LAN PHUONG THI (DDS)
Entity type:Individual
Prefix:
First Name:LAN PHUONG
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9353 BOLSA AVE
Mailing Address - Street 2:SUITE E & F
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5951
Mailing Address - Country:US
Mailing Address - Phone:714-892-8191
Mailing Address - Fax:714-892-9911
Practice Address - Street 1:9353 BOLSA AVE
Practice Address - Street 2:SUITE E & F
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5951
Practice Address - Country:US
Practice Address - Phone:714-892-8191
Practice Address - Fax:714-892-9911
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9239001Medicaid
521246Medicare UPIN