Provider Demographics
NPI:1467669754
Name:TRAN, KENNETH Q (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:Q
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 1:891 BAKER ST
Mailing Address - Street 2:SUITE A12
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4361
Mailing Address - Country:US
Mailing Address - Phone:714-641-0337
Mailing Address - Fax:714-641-5659
Practice Address - Street 1:891 BAKER ST
Practice Address - Street 2:SUITE A12
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4361
Practice Address - Country:US
Practice Address - Phone:714-641-0337
Practice Address - Fax:714-641-5659
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA443721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice