Healthcare Provider Details

I. General information

NPI: 1255799276
Provider Name (Legal Business Name): KELLY THAO TRAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12032 FAIRCHILD ST
GARDEN GROVE CA
92845-1529
US

IV. Provider business mailing address

12032 FAIRCHILD ST
GARDEN GROVE CA
92845-1529
US

V. Phone/Fax

Practice location:
  • Phone: 714-249-5050
  • Fax:
Mailing address:
  • Phone: 714-249-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number770299
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95003689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: