Healthcare Provider Details

I. General information

NPI: 1750448486
Provider Name (Legal Business Name): LAN THAO TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 750
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 750
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2101
  • Fax: 206-386-2555
Mailing address:
  • Phone: 206-386-2101
  • Fax: 206-386-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number00042279
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: