Provider Demographics
NPI:1962235903
Name:TRAN, KENNY LONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNY
Middle Name:LONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10652 HARCOURT AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5939
Mailing Address - Country:US
Mailing Address - Phone:408-489-0428
Mailing Address - Fax:
Practice Address - Street 1:10652 HARCOURT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5939
Practice Address - Country:US
Practice Address - Phone:408-489-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist