Provider Demographics
NPI:1558977900
Name:TRAN, KATHY CAMVAN (LPT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:CAMVAN
Last Name:TRAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6414
Mailing Address - Country:US
Mailing Address - Phone:209-636-5355
Mailing Address - Fax:209-636-5356
Practice Address - Street 1:1803 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6414
Practice Address - Country:US
Practice Address - Phone:209-636-5355
Practice Address - Fax:209-636-5356
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician