Healthcare Provider Details

I. General information

NPI: 1649108887
Provider Name (Legal Business Name): KEVIN TRAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 3RD ST S FL 32250
JACKSONVILLE BEACH FL
32250-4021
US

IV. Provider business mailing address

13477 CABRERA CT
JACKSONVILLE FL
32246-5564
US

V. Phone/Fax

Practice location:
  • Phone: 904-441-0632
  • Fax:
Mailing address:
  • Phone: 904-525-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: