Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DDS64222 | CA |
NPI | 1073873410 |
---|---|
Provider Name | Dr. Lana Tran |
First Address | Costa Mesa, CA 92626-2705 |
Second Address | Costa Mesa, CA 92626-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2012 |
Last Update Date | 22/01/2022 |