MEDICARE: KENNY TAN TRAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA67743	CA

General Provider Information

NPI Number	:	1659221364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY TAN TRAN

Provider Business Mailing Address
First Line	:	1731 E 120TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14281 BEACH BLVD
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4567
Country	:	US
Telephone Number	:	714-893-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	04/01/2026

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Directions to “ KENNY TAN TRAN ” Practice Location

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