Provider Demographics
NPI:1023151669
Name:TRAN, KHIET MINH (DDS)
Entity type:Individual
Prefix:DR
First Name:KHIET
Middle Name:MINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 VIA DE GUADALUPE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2561
Mailing Address - Country:US
Mailing Address - Phone:408-923-7073
Mailing Address - Fax:408-923-5293
Practice Address - Street 1:7836 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6467
Practice Address - Country:US
Practice Address - Phone:503-288-3107
Practice Address - Fax:503-287-4748
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125026Medicaid