Provider Demographics
NPI:1891840716
Name:TRAN, KIM DUNG (OD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DUNG
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 HAVENCREST CRT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1225
Mailing Address - Country:US
Mailing Address - Phone:832-640-5015
Mailing Address - Fax:
Practice Address - Street 1:1919 N. MAIN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-3305
Practice Address - Country:US
Practice Address - Phone:281-485-7672
Practice Address - Fax:281-997-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6661T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist