Healthcare Provider Details

I. General information

NPI: 1528690013
Provider Name (Legal Business Name): KIM YEN TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HALE AVE STE F1
MORGAN HILL CA
95037-4349
US

IV. Provider business mailing address

732 TIMOR CT
SAN JOSE CA
95127-1045
US

V. Phone/Fax

Practice location:
  • Phone: 408-776-9882
  • Fax:
Mailing address:
  • Phone: 408-529-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: