Provider Demographics
NPI:1124868385
Name:TRAN, KENNY HUNG (DMD)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:HUNG
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4424
Mailing Address - Country:US
Mailing Address - Phone:714-230-9519
Mailing Address - Fax:
Practice Address - Street 1:4365 E PECOS RD STE 127
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8052
Practice Address - Country:US
Practice Address - Phone:480-331-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0121421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice