Provider Demographics
NPI:1275786733
Name:VU, KIM TRAN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:TRAN
Last Name:VU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 COFFEE RD
Mailing Address - Street 2:STE. G-2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2427
Mailing Address - Country:US
Mailing Address - Phone:209-491-2224
Mailing Address - Fax:209-572-2477
Practice Address - Street 1:2020 COFFEE RD
Practice Address - Street 2:STE. G-2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2427
Practice Address - Country:US
Practice Address - Phone:209-491-2224
Practice Address - Fax:209-572-2477
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice