Provider Demographics
NPI:1033787064
Name:TRAN, KIM NGOC (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5531 ATASCOCITA TIMBERS N
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2693
Mailing Address - Country:US
Mailing Address - Phone:832-794-5345
Mailing Address - Fax:
Practice Address - Street 1:6290 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5379
Practice Address - Country:US
Practice Address - Phone:303-766-0545
Practice Address - Fax:303-766-0624
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA390200000X
390200000X
CO3715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program