Provider Demographics
NPI:1124161112
Name:TRAN, LOAN KIM (OD)
Entity type:Individual
Prefix:DR
First Name:LOAN
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1282 STABLER LN
Mailing Address - Street 2:STE. 620
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2625
Mailing Address - Country:US
Mailing Address - Phone:530-755-9886
Mailing Address - Fax:530-755-9885
Practice Address - Street 1:1282 STABLER LN
Practice Address - Street 2:STE. 620
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2625
Practice Address - Country:US
Practice Address - Phone:530-755-9886
Practice Address - Fax:530-755-9885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASD0114001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114001Medicare PIN
CA5650600001Medicare NSC
CAU98864Medicare UPIN