Provider Demographics
NPI:1013678192
Name:TRAN, KENNETH (DDS, MS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:NGOC-PHUONG
Other - Middle Name:HUU
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16299 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5425
Mailing Address - Country:US
Mailing Address - Phone:678-964-4969
Mailing Address - Fax:
Practice Address - Street 1:16299 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5425
Practice Address - Country:US
Practice Address - Phone:678-964-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1071171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice