Provider Demographics
NPI:1790785863
Name:TRAN, LONG KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LONG
Middle Name:KIM
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 1:4448 UNIVERSITY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1739
Mailing Address - Country:US
Mailing Address - Phone:619-521-6799
Mailing Address - Fax:619-521-6799
Practice Address - Street 1:4448 UNIVERSITY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1739
Practice Address - Country:US
Practice Address - Phone:619-521-6799
Practice Address - Fax:619-521-6799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice