Provider Demographics
NPI:1295723666
Name:TRAN, KHANH (OD)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6850 LINCOLN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4180
Mailing Address - Country:US
Mailing Address - Phone:714-927-5192
Mailing Address - Fax:253-252-8801
Practice Address - Street 1:6850 LINCOLN AVE STE 204
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4180
Practice Address - Country:US
Practice Address - Phone:714-927-5192
Practice Address - Fax:253-252-8801
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12866152WP0200X, 152WV0400X, 152WX0102X, 152W00000X, 152WL0500X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
BZ239YOtherMEDICARE PTAN