Provider Demographics
NPI:1093783797
Name:TRAN, KELLY HIEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:HIEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2923 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3216
Mailing Address - Country:US
Mailing Address - Phone:714-731-0215
Mailing Address - Fax:714-731-2858
Practice Address - Street 1:2923 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8909
Practice Address - Country:US
Practice Address - Phone:714-731-0215
Practice Address - Fax:714-731-2858
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9711T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0097111Medicaid
CASD0097111Medicaid