Provider Demographics
NPI:1215068622
Name:TRAN, TAMMY NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TU
Other - Middle Name:NGOC
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1938 W DEEREFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7138
Mailing Address - Country:US
Mailing Address - Phone:714-241-7028
Mailing Address - Fax:
Practice Address - Street 1:990 CHERRY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5940
Practice Address - Country:US
Practice Address - Phone:562-987-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48560Medicaid