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General NPI Number Information
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NPI Number | 1770067571
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Entity Type | Individual
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Provider Name | KEVIN TRAN DDS
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Gender | Male
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 11035 LONG BEACH BLVD STE 5
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City | LYNWOOD
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State | CA
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Zip | 90262-2570
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Country | US
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Telephone | 310-945-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 3217 OVERLAND AVE APT 6114
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City | LOS ANGELES
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State | CA
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Zip | 90034-4515
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Country | US
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Telephone | 805-298-3593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103122
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License Number State | CA
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