Healthcare Provider Details

I. General information

NPI: 1972372985
Provider Name (Legal Business Name): KENNETH TRAN DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16299 PARAMOUNT BLVD
PARAMOUNT CA
90723-5425
US

IV. Provider business mailing address

20913 NEW HAMPSHIRE AVE
TORRANCE CA
90502-1753
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-4740
  • Fax:
Mailing address:
  • Phone: 678-964-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH TRAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 678-964-4969