Provider Demographics
NPI:1780016154
Name:TRAN, KEVIN HOANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:HOANG
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S RAYMOND AVE UNIT 507
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4118
Mailing Address - Country:US
Mailing Address - Phone:714-467-5194
Mailing Address - Fax:
Practice Address - Street 1:3201 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5001
Practice Address - Country:US
Practice Address - Phone:213-251-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist