Healthcare Provider Details

I. General information

NPI: 1134305147
Provider Name (Legal Business Name): KIET TRAN, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65100 DATE PALM AVE BLDG L
MECCA CA
92254-6610
US

IV. Provider business mailing address

41800 WASHINGTON ST #B105-425
BERMUDA DUNES CA
92203-8150
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44552
License Number StateCA

VIII. Authorized Official

Name: DR. KIET TRAN
Title or Position: CEO/CHAIR
Credential: DDS
Phone: 760-899-2322