Provider Demographics
NPI:1396831889
Name:TRAN, KIEN PHUC (MD)
Entity Type:Individual
Prefix:DR
First Name:KIEN
Middle Name:PHUC
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 1:15491 PASADENA AVE APT 87
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4247
Mailing Address - Country:US
Mailing Address - Phone:832-287-6252
Mailing Address - Fax:
Practice Address - Street 1:15491 PASADENA AVE APT 87
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4247
Practice Address - Country:US
Practice Address - Phone:832-287-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88769207R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered282N00000XHospitalsGeneral Acute Care Hospital