Provider Demographics
NPI:1770147134
Name:TRAN, JULIA KIM
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 PUENTE AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5923
Mailing Address - Country:US
Mailing Address - Phone:626-814-1483
Mailing Address - Fax:626-814-1493
Practice Address - Street 1:1550 PUENTE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5923
Practice Address - Country:US
Practice Address - Phone:626-814-1483
Practice Address - Fax:626-814-1493
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist