Provider Demographics
NPI:1689867384
Name:TRAN, KHEIM THANH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KHEIM
Middle Name:THANH
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 1:1 NIGHTSHORE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1519
Mailing Address - Country:US
Mailing Address - Phone:949-230-7348
Mailing Address - Fax:
Practice Address - Street 1:21149 NEWPORT COAST DR
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1122
Practice Address - Country:US
Practice Address - Phone:949-760-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice