Healthcare Provider Details

I. General information

NPI: 1912318205
Provider Name (Legal Business Name): KIM THUY TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIM THUY TRAN M.D

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S MAIN ST FL 3
FORT WORTH TX
76104-2410
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

V. Phone/Fax

Practice location:
  • Phone: 817-882-2590
  • Fax:
Mailing address:
  • Phone: 214-947-5400
  • Fax: 214-947-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ7120
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10049729
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: