MEDICARE: KIMLY THI TRAN OD

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	12970T	CA

General Provider Information

NPI Number	:	1093829921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMLY THI TRAN OD

Provider Business Mailing Address
First Line	:	11431 STONECRESS AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-2452
Country	:	US
Telephone Number	:	714-902-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 PALO VERDE AVE
Second Line	:	STE #103
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4132
Country	:	US
Telephone Number	:	562-421-2757
Fax Number	:	562-420-7267

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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Directions to “ KIMLY THI TRAN OD” Practice Location

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