1134305147 NPI number — KIET TRAN, DDS, INC

Table of content: (NPI 1134305147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134305147 NPI number — KIET TRAN, DDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIET TRAN, DDS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134305147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41800 WASHINGTON ST
Provider Second Line Business Mailing Address:
#B105-425
Provider Business Mailing Address City Name:
BERMUDA DUNES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92203-8150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65100 DATE PALM AVE
Provider Second Line Business Practice Location Address:
BLDG L
Provider Business Practice Location Address City Name:
MECCA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92254-6610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-396-3888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
KIET
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/CHAIR
Authorized Official Telephone Number:
760-899-2322

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  44552 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)