Healthcare Provider Details

I. General information

NPI: 1972382067
Provider Name (Legal Business Name): KELLEY TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 290
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 290
NEWPORT BEACH CA
92663-3664
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-7498
  • Fax: 949-679-2650
Mailing address:
  • Phone: 949-764-7498
  • Fax: 949-679-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: