Healthcare Provider Details

I. General information

NPI: 1639097785
Provider Name (Legal Business Name): KEVIN KHOI TRAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN TRAN OD

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34806 YUCAIPA BLVD
YUCAIPA CA
92399-4235
US

IV. Provider business mailing address

34806 YUCAIPA BLVD
YUCAIPA CA
92399-4235
US

V. Phone/Fax

Practice location:
  • Phone: 909-797-0134
  • Fax:
Mailing address:
  • Phone: 909-797-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: