Provider Demographics
NPI:1225100753
Name:TRAN, FELICIA KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PHUONG
Other - Middle Name:KIMTHI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6301 BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4030
Mailing Address - Country:US
Mailing Address - Phone:714-994-5290
Mailing Address - Fax:714-994-8090
Practice Address - Street 1:6301 BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4030
Practice Address - Country:US
Practice Address - Phone:714-994-5290
Practice Address - Fax:714-994-8090
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099930Medicaid
CAGR0099930Medicaid
CAH07397Medicare UPIN