Healthcare Provider Details

I. General information

NPI: 1073796884
Provider Name (Legal Business Name): JACQUELINE VAN TRAN MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW SUITE 503
BURIEN WA
98166-3049
US

IV. Provider business mailing address

16259 SYLVESTER RD SW SUITE 503
BURIEN WA
98166-3049
US

V. Phone/Fax

Practice location:
  • Phone: 206-246-3800
  • Fax: 206-246-3583
Mailing address:
  • Phone: 206-246-3800
  • Fax: 206-246-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number33283
License Number StateWA

VIII. Authorized Official

Name: JACQUELINE VAN TRAN
Title or Position: PRESIDENT
Credential: MD
Phone: 206-246-3800