Healthcare Provider Details

I. General information

NPI: 1518491836
Provider Name (Legal Business Name): KIM NGAN NGOC TRAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1606
US

IV. Provider business mailing address

253 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1606
US

V. Phone/Fax

Practice location:
  • Phone: 909-860-1144
  • Fax:
Mailing address:
  • Phone: 909-860-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22930
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number302581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: