Provider Demographics
NPI:1669154472
Name:TRAN, VICTORIA THAOVI (DDS)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:THAOVI
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 1:3277 STANDER DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-3133
Mailing Address - Country:US
Mailing Address - Phone:408-464-9540
Mailing Address - Fax:
Practice Address - Street 1:3795 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3057
Practice Address - Country:US
Practice Address - Phone:928-352-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109044122300000X
TX40132122300000X
AZD011948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist