Provider Demographics
NPI:1720233356
Name:KY MINH TRAN M D INCORPORATED
Entity Type:Organization
Organization Name:KY MINH TRAN M D INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KY
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-376-3288
Mailing Address - Street 1:PO BOX 2332
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-7332
Mailing Address - Country:US
Mailing Address - Phone:714-739-5959
Mailing Address - Fax:714-443-5763
Practice Address - Street 1:4332 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3564
Practice Address - Country:US
Practice Address - Phone:714-376-3288
Practice Address - Fax:714-443-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty