Provider Demographics
NPI:1114234481
Name:TRAN, KATHLEEN V
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:V
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 1:4430 FAIRFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2745
Mailing Address - Country:US
Mailing Address - Phone:562-256-6913
Mailing Address - Fax:
Practice Address - Street 1:4430 FAIRFIELD WAY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2745
Practice Address - Country:US
Practice Address - Phone:562-256-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51568OtherSTATE LICENSE