Provider Demographics
NPI:1205908290
Name:TRAN, PHUONG (DDS)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:
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 1:1103 S HARBOR BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2347
Mailing Address - Country:US
Mailing Address - Phone:714-839-3926
Mailing Address - Fax:
Practice Address - Street 1:1103 S HARBOR BLVD STE D
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2347
Practice Address - Country:US
Practice Address - Phone:714-839-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist