Provider Demographics
NPI:1093831893
Name:TRAN, KEVIN THANH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8188 SIERRA AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3575
Mailing Address - Country:US
Mailing Address - Phone:909-434-0865
Mailing Address - Fax:
Practice Address - Street 1:8188 SIERRA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3575
Practice Address - Country:US
Practice Address - Phone:909-434-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice