Provider Demographics
NPI:1376387993
Name:TRAN, KATHY KIM (DMD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 GLENBURY CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-3997
Mailing Address - Country:US
Mailing Address - Phone:817-455-9922
Mailing Address - Fax:
Practice Address - Street 1:3215 KIRNWOOD DR STE 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4433
Practice Address - Country:US
Practice Address - Phone:972-709-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist