Provider Demographics
NPI:1669108759
Name:TRAN, TRANG N
Entity type:Individual
Prefix:
First Name:TRANG
Middle Name:N
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMI
Other - Middle Name:N
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:330 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-6811
Mailing Address - Country:US
Mailing Address - Phone:805-335-1902
Mailing Address - Fax:
Practice Address - Street 1:330 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-6811
Practice Address - Country:US
Practice Address - Phone:805-335-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician