Provider Demographics
NPI:1487061107
Name:TRAN, MICHAEL ADAM (DDS, MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 RUNWAY RD UNIT 320
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2394
Mailing Address - Country:US
Mailing Address - Phone:949-702-1133
Mailing Address - Fax:
Practice Address - Street 1:16700 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3243
Practice Address - Country:US
Practice Address - Phone:310-921-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA636171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics