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MTRAN DMD PROFESSIONAL CORPORATION
Complete NPI Record 1316553282
Clinic/Center - Dental in Tustin, CA

NPI Status: Active since September 16, 2020

Contact Information

1101 BRYAN AVE STE D
TUSTIN, CA
ZIP 92780
Phone: (714) 838-0790
Fax: (714) 838-0515

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Is Organization Subpart
  28. Authorized Official Name Prefix Text
  29. Authorized Official Credential Text
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1316553282. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1316553282
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 1101 BRYAN AVE STE D
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: TUSTIN
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 927804401
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7148380790
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Fax Number: 7148380515
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1101 BRYAN AVE STE D
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Practice Location Address City Name: TUSTIN
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CA
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 927804401
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 7148380790
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7148380515
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/16/2020
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 1/18/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Last Name: TRAN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MICHAEL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official Title or Position: DENTIST/OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 7148380790
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QD0000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: DMD
NPI Certification Date: 1/18/2021