Provider Demographics
NPI:1245764968
Name:TRAN-NGUYEN, KIMBERLY (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TRAN-NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 TRACE MEADOW LOOP APT 303
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2636
Mailing Address - Country:US
Mailing Address - Phone:305-801-8877
Mailing Address - Fax:
Practice Address - Street 1:6421 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3102
Practice Address - Country:US
Practice Address - Phone:813-888-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN228351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program