Provider Demographics
NPI:1588298939
Name:TRAN, CHRISTINE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CAMINO KATIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-9420
Mailing Address - Country:US
Mailing Address - Phone:562-508-7845
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DR STE 306
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7635
Practice Address - Country:US
Practice Address - Phone:949-644-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104614122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist