Provider Demographics
NPI:1952703423
Name:TIEN MANH TRAN DDS, INC.
Entity Type:Organization
Organization Name:TIEN MANH TRAN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:MANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-227-7264
Mailing Address - Street 1:3124 SENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1257
Mailing Address - Country:US
Mailing Address - Phone:408-227-7264
Mailing Address - Fax:408-227-7265
Practice Address - Street 1:3124 SENTER RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1257
Practice Address - Country:US
Practice Address - Phone:408-227-7264
Practice Address - Fax:408-227-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00642Medicare UPIN