Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 53109 | CA |
NPI | 1053465955 |
---|---|
Provider Name | Dr. Nguyen Nhu Tran |
First Address | Los Angeles, CA 90022-1606 |
Second Address | Los Angeles, CA 90022-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 13/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
53109 | DELTA DENTAL (01) | CA |