Provider Demographics
NPI:1053313270
Name:TRAN, KY (MD)
Entity Type:Individual
Prefix:DR
First Name:KY
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2332
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-7332
Mailing Address - Country:US
Mailing Address - Phone:562-430-1235
Mailing Address - Fax:562-452-8972
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:STE 104
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2000
Practice Address - Country:US
Practice Address - Phone:562-430-1235
Practice Address - Fax:562-452-8972
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH74389Medicare UPIN
LA5CG91Medicare ID - Type UnspecifiedGROUP NUMBER
LA1445428Medicaid