Healthcare Provider Details

I. General information

NPI: 1831811033
Provider Name (Legal Business Name): KIM-THOA TRAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

IV. Provider business mailing address

20015 104TH PL SE
KENT WA
98031-1563
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0930
  • Fax:
Mailing address:
  • Phone: 253-856-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number00098007
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: