Provider Demographics
NPI:1174931661
Name:TRAN, TIEN
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 SUNLIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4918
Mailing Address - Country:US
Mailing Address - Phone:412-626-2183
Mailing Address - Fax:
Practice Address - Street 1:21091 RIDER ST.
Practice Address - Street 2:SUITE 203
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-4026
Practice Address - Country:US
Practice Address - Phone:951-322-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist