Healthcare Provider Details

I. General information

NPI: 1003560616
Provider Name (Legal Business Name): TRANG THI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 09/24/2026
Certification Date: 02/11/2022
Deactivation Date: 05/20/2025
Reactivation Date: 09/24/2026

III. Provider practice location address

3643 W 133RD ST
HAWTHORNE CA
90250-6217
US

IV. Provider business mailing address

3643 W 133RD ST
HAWTHORNE CA
90250-6217
US

V. Phone/Fax

Practice location:
  • Phone: 310-297-0194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: