Healthcare Provider Details

I. General information

NPI: 1396831889
Provider Name (Legal Business Name): KIEN PHUC TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15491 PASADENA AVE APT 87
TUSTIN CA
92780-4247
US

IV. Provider business mailing address

15491 PASADENA AVE APT 87
TUSTIN CA
92780-4247
US

V. Phone/Fax

Practice location:
  • Phone: 832-287-6252
  • Fax:
Mailing address:
  • Phone: 832-287-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA88769
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA88769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: