Provider Demographics
NPI:1134305147
Name:KIET TRAN, DDS, INC
Entity Type:Organization
Organization Name:KIET TRAN, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIET
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-899-2322
Mailing Address - Street 1:41800 WASHINGTON ST
Mailing Address - Street 2:#B105-425
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-8150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65100 DATE PALM AVE
Practice Address - Street 2:BLDG L
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254-6610
Practice Address - Country:US
Practice Address - Phone:760-396-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty