Healthcare Provider Details

I. General information

NPI: 1063511509
Provider Name (Legal Business Name): KIM HOANG TRAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 ACADEMY AVE
SANGER CA
93657-2128
US

IV. Provider business mailing address

263 ACADEMY AVE
SANGER CA
93657-2128
US

V. Phone/Fax

Practice location:
  • Phone: 559-876-1031
  • Fax: 559-876-1341
Mailing address:
  • Phone: 559-876-1031
  • Fax: 559-876-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: