Healthcare Provider Details

I. General information

NPI: 1699152397
Provider Name (Legal Business Name): KIM VAN TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 121ST WAY NE STE 100
KIRKLAND WA
98034-3008
US

IV. Provider business mailing address

13030 121ST WAY NE STE 100
KIRKLAND WA
98034-3008
US

V. Phone/Fax

Practice location:
  • Phone: 425-814-5170
  • Fax:
Mailing address:
  • Phone: 425-814-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61457390
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: