Provider Demographics
NPI:1598816936
Name:TRAN, KIM-THANH THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM-THANH
Middle Name:THI
Last Name:TRAN
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 1:6897 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5109
Mailing Address - Country:US
Mailing Address - Phone:714-952-3044
Mailing Address - Fax:714-952-3045
Practice Address - Street 1:6897 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5109
Practice Address - Country:US
Practice Address - Phone:714-952-3044
Practice Address - Fax:714-952-3045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice