Healthcare Provider Details

I. General information

NPI: 1447902515
Provider Name (Legal Business Name): KELLY TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 CRENSHAW BLVD
INGLEWOOD CA
90303-2807
US

IV. Provider business mailing address

1501 COLLEGE VIEW DR APT D
MONTEREY PARK CA
91754-5130
US

V. Phone/Fax

Practice location:
  • Phone: 323-757-2811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: