Provider Demographics
NPI:1205485687
Name:TRAN, DIANA QUYNH ANH (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:QUYNH ANH
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 1:15322 SPAR ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5338
Mailing Address - Country:US
Mailing Address - Phone:714-660-8791
Mailing Address - Fax:
Practice Address - Street 1:3810 LA CRESCENTA AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3914
Practice Address - Country:US
Practice Address - Phone:818-249-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1042201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice