Individual
KENNETH K TRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
293 S MAIN ST, ORANGE, CA 92868-3843
(714) 838-8848
Mailing address
17360 BROOKHURST ST, ATTN: MCMF- CREDENTIALING DEPARTMENT, FOUNTAIN VALLEY, CA 92708-3720
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G67475
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
G67475
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G674750
—
CA
Enumeration date
10/19/2005
Last updated
02/18/2015
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