Provider Demographics
NPI:1285636209
Name:TRAN, KIET THE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIET
Middle Name:THE
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W CESAR E CHAVEZ AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-6602
Mailing Address - Country:US
Mailing Address - Phone:213-617-8246
Mailing Address - Fax:213-617-2363
Practice Address - Street 1:815 W CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-6602
Practice Address - Country:US
Practice Address - Phone:213-617-8246
Practice Address - Fax:213-617-2363
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43094OtherSTATE MEDICAL LICENSE
CA00A430940Medicaid
CAKT-A43094Medicare PIN
CAA43094OtherSTATE MEDICAL LICENSE