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General NPI Number Information
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NPI Number | 1073796884
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Entity Type | Organization
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Legal Business Name | JACQUELINE VAN TRAN MD PS
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 16259 SYLVESTER RD SW SUITE 503
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City | BURIEN
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State | WA
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Zip | 98166-3049
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Country | US
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Telephone | 206-246-3800
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Fax | 206-246-3583
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Provider Business Mailing Address
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Address Line | 16259 SYLVESTER RD SW SUITE 503
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City | BURIEN
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State | WA
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Zip | 98166-3049
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Country | US
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Telephone | 206-246-3800
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Fax | 206-246-3583
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACQUELINE VAN TRAN
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Credential | MD
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Telephone | 206-246-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 33283
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License Number State | WA
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