Individual provider Active NPI

An-Vinh Tran

  • Dentist
  • Marysville, WA
National Provider Identifier
1043008204
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8236 Issued in NV
Practice address
17103 28TH Dr NE Ste 104
Marysville, WA 98271-4830
Phone
(360) 208-0492
NPI assigned
Apr 28, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DENT.DE.70135737 WA
Dentist 122300000X 8236 NV Primary

Addresses

Primary practice location

17103 28TH Dr NE Ste 104
Marysville, WA 98271-4830

Mailing address

17103 28TH Dr NE Ste 104
Marysville, WA 98271-4830
Phone (360) 208-0492

Other practice location 1

4950 W Sahara Ave Ste 100
Las Vegas, NV 89146-3462
Phone (702) 680-1525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251009001442 NV Order and Referring Only - DentistPractitioner - Dentist 2769989383

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8236NVMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Tang Sahara Modern Dentistry, PC CurrentSince Aug 17, 2025 Accepting new patients

Locations

4950 W Sahara Ave
#100
Las Vegas, NV 89146
Phone (702) 680-1525

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1043008204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17103 28TH DR NE STE 104",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982714830",
            "telephone_number": "360-208-0492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17103 28TH DR NE STE 104",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982714830",
            "telephone_number": "360-208-0492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4950 W Sahara Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891463462",
            "country_code": "US",
            "telephone_number": "702-680-1525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRAN",
        "first_name": "AN-VINH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-28",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DENT.DE.70135737",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "8236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, WA

Sources for this page

Verify at the official NPI Registry.