Healthcare Provider Details

I. General information

NPI: 1487295549
Provider Name (Legal Business Name): KELLY TRAM TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRAM BAO TRAN

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N PROSPECT AVE STE 302
REDONDO BEACH CA
90277-3043
US

IV. Provider business mailing address

9392 DOWNING CIR
WESTMINSTER CA
92683-6520
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-1515
  • Fax: 310-798-3131
Mailing address:
  • Phone: 714-654-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57368
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: