MEDICARE: SURGICAL & ENDOVASCULAR SPECIALIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD00043987	WA

General Provider Information

NPI Number	:	1316974603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL & ENDOVASCULAR SPECIALIST

Provider Business Mailing Address
First Line	:	3104 SQUALICUM PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 SQUALICUM PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1936
Country	:	US
Telephone Number	:	360-733-6540
Fax Number	:	360-733-4674

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HOANG SIMON TRAN
Credential	:	MD
Telephone Number	:	360-733-6540

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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