Provider Demographics
NPI:1043438773
Name:TRAN, TAM-HUONG NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:TAM-HUONG
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2254
Mailing Address - Country:US
Mailing Address - Phone:818-363-3382
Mailing Address - Fax:818-363-4002
Practice Address - Street 1:11155 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2254
Practice Address - Country:US
Practice Address - Phone:818-363-3382
Practice Address - Fax:818-363-4002
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4700829OtherTAX ID
CAB42434Medicare ID - Type Unspecified