Provider Demographics
NPI:1710030911
Name:TRAN, KEVIN H (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:31444 S CANFIELD AVE
Mailing Address - Street 2:APT #107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4377
Mailing Address - Country:US
Mailing Address - Phone:714-875-1969
Mailing Address - Fax:
Practice Address - Street 1:8471 BEVERLY BLVD
Practice Address - Street 2:STE 105 BEVERLY PLAZA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3450
Practice Address - Country:US
Practice Address - Phone:310-360-8220
Practice Address - Fax:310-360-8212
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA12661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01477Medicare UPIN