MEDICARE: DR. KELLY HIEN TRAN O.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	152W00000X	Optometrist	9711T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093783797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY HIEN TRAN O.D

Provider Business Mailing Address
First Line	:	2923 EL CAMINO REAL
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92620-3216
Country	:	US
Telephone Number	:	714-731-0215
Fax Number	:	714-731-2858

Provider Business Practice Location Address
First Line	:	2923 EL CAMINO REAL
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-731-0215
Fax Number	:	714-731-2858

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/21/2022

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