Provider Demographics
NPI:1033316146
Name:TRAN, ANDY VU (DDS)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:VU
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5091
Mailing Address - Country:US
Mailing Address - Phone:714-401-3956
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 240
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-5091
Practice Address - Country:US
Practice Address - Phone:661-296-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist