MEDICARE: DR. KY TRAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	53142	CA

General Provider Information

NPI Number	:	1053313270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KY TRAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2332
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-7332
Country	:	US
Telephone Number	:	562-430-1235
Fax Number	:	562-452-8972

Provider Business Practice Location Address
First Line	:	3791 KATELLA AVE
Second Line	:	STE 104
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2000
Country	:	US
Telephone Number	:	562-430-1235
Fax Number	:	562-452-8972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/13/2021

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