Provider Demographics
NPI:1083072664
Name:TRAN, JOANN KIM HA
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:KIM HA
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LONG BEACH BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4883
Mailing Address - Country:US
Mailing Address - Phone:504-339-1984
Mailing Address - Fax:
Practice Address - Street 1:15655 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:424-297-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67071223G0001X
CADDS1021111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice