Healthcare Provider Details

I. General information

NPI: 1043915739
Provider Name (Legal Business Name): KATHYANN PHUONG TRAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8027 CLEARWATER GLEN CT
RICHMOND TX
77407-1107
US

IV. Provider business mailing address

8027 CLEARWATER GLEN CT
RICHMOND TX
77407-1107
US

V. Phone/Fax

Practice location:
  • Phone: 832-528-4471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number20371
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: