Provider Demographics
NPI:1073664736
Name:COLOMA, KIM-UYEN TRAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM-UYEN
Middle Name:TRAN
Last Name:COLOMA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIM-UYEN
Other - Middle Name:LE
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:721 CANTOR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620
Mailing Address - Country:US
Mailing Address - Phone:949-872-2773
Mailing Address - Fax:
Practice Address - Street 1:7890 HAVEN AVE STE 17
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3051
Practice Address - Country:US
Practice Address - Phone:909-987-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12662T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist