Healthcare Provider Details

I. General information

NPI: 1356921779
Provider Name (Legal Business Name): KHIEM NGOC TRAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 NW MARKET ST
SEATTLE WA
98107-3908
US

IV. Provider business mailing address

225 NE 185TH ST
SHORELINE WA
98155-2103
US

V. Phone/Fax

Practice location:
  • Phone: 206-586-8442
  • Fax:
Mailing address:
  • Phone: 253-579-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61168622
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: