Healthcare Provider Details

I. General information

NPI: 1881155992
Provider Name (Legal Business Name): JOHNSON TRAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S 336TH ST STE C
FEDERAL WAY WA
98003-6329
US

IV. Provider business mailing address

PO BOX 26730
FEDERAL WAY WA
98093-3730
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13853135-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOP61637513
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: