Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 1797 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 60421 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 143261 | CA |
NPI | 1588980767 |
---|---|
Provider Name | Lisa Nguyen Tran |
First Address | Santa Ana, CA 92705-3555 |
Second Address | Santa Ana, CA 92705-3555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 23/10/2019 |