1588977169 NPI number — TRANH MY LY RDHAP

Table of content: TRANH MY LY RDHAP (NPI 1588977169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588977169 NPI number — TRANH MY LY RDHAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LY
Provider First Name:
TRANH
Provider Middle Name:
MY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDHAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588977169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 SOUTH PAULA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-251-2974
Provider Business Mailing Address Fax Number:
714-956-7162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SOUTH PAULA LN
Provider Second Line Business Practice Location Address:
MOBILE DENTAL HYGIENIST
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-251-2974
Provider Business Practice Location Address Fax Number:
714-956-7162
Provider Enumeration Date:
07/23/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  19396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 124Q00000X , with the licence number: RDHAP306 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)