Healthcare Provider Details

I. General information

NPI: 1417750365
Provider Name (Legal Business Name): KELLY MAI-TRAM TRAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

9825 ALMEDA OAKS DR
HOUSTON TX
77075-5603
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: