Provider Demographics
NPI:1225270911
Name:STAFFORD, KIM THIEN TRAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:THIEN TRAN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:THIEN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3576
Mailing Address - Country:US
Mailing Address - Phone:714-456-7002
Mailing Address - Fax:
Practice Address - Street 1:800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3576
Practice Address - Country:US
Practice Address - Phone:714-456-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine