Provider Demographics
NPI:1194609909
Name:TRAN, KELLY (CNIM)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17477
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-7477
Mailing Address - Country:US
Mailing Address - Phone:281-768-6743
Mailing Address - Fax:
Practice Address - Street 1:3130 GRANTS LAKE BLVD UNIT 17477
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77496-0869
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5734246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic