Provider Demographics
NPI:1629463930
Name:TRAN, KIM XUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:XUAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-872-2080
Mailing Address - Fax:650-615-4607
Practice Address - Street 1:1001 SNEATH LN STE 211
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:650-872-2080
Practice Address - Fax:650-615-4607
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice