Provider Demographics
NPI:1730218199
Name:TRAN, TAM THANH (DDS)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20941 HACKNEY ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2746
Mailing Address - Country:US
Mailing Address - Phone:818-274-2957
Mailing Address - Fax:
Practice Address - Street 1:18048 SATICOY ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3253
Practice Address - Country:US
Practice Address - Phone:818-708-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51382OtherMEDICAL