Individual provider Active NPI

Phuong Tran, DDS

  • Dentist
  • Santa Ana, CA
National Provider Identifier
1205908290
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
41562 Issued in CA
Practice address
1103 S Harbor Blvd Ste D
Santa Ana, CA 92704-2347
Phone
(714) 839-3926
NPI assigned
Nov 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 41562 CA Primary

Addresses

Primary practice location

1103 S Harbor Blvd Ste D
Santa Ana, CA 92704-2347

Mailing address

1103 S Harbor Blvd Ste D
Santa Ana, CA 92704-2347
Phone (714) 839-3926

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20210707000448 CA Practitioner - Oral Surgery 2567864077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41562CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Phuong Phi Tran DDS Inc Dentist CurrentSince Mar 30, 2021 Accepting new patients

Locations

1103 S Harbor Blvd
Ste D
Santa Ana, CA 92704
Phone (714) 839-3926

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205908290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 S HARBOR BLVD STE D",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927042347",
            "telephone_number": "714-839-3926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 S HARBOR BLVD STE D",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927042347",
            "telephone_number": "714-839-3926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "PHUONG",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.