1780826974 NPI number — LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION

Table of content: (NPI 1780826974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780826974 NPI number — LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LILY TULAN TRAN, DDS, A PROFESSIONAL DENTAL CORPOPRATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1780826974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2126 N TUSTIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705-7828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-558-9236
Provider Business Mailing Address Fax Number:
714-558-9237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2126 N TUSTIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-7828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-558-9236
Provider Business Practice Location Address Fax Number:
714-558-9237
Provider Enumeration Date:
04/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
LILY
Authorized Official Middle Name:
TULAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-558-9236

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  41801 , 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)

  • Identifier: B4180101 . This is a "CALIFORNIA MEDI-CAL DENTAL PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com