Provider Demographics
NPI:1588980767
Name:TRAN, LISA NGUYEN (DDS MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NGUYEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:436 S GLASSELL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1906
Mailing Address - Country:US
Mailing Address - Phone:714-998-7450
Mailing Address - Fax:714-998-2857
Practice Address - Street 1:436 S GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1906
Practice Address - Country:US
Practice Address - Phone:714-998-7450
Practice Address - Fax:714-998-2857
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17971223S0112X
CA604211223S0112X
CA143261204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery