Healthcare Provider Details

I. General information

NPI: 1811889702
Provider Name (Legal Business Name): KENNY TRAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

IV. Provider business mailing address

834 HELLYER AVE
SAN JOSE CA
95111-1526
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax:
Mailing address:
  • Phone: 408-826-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95265312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: