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General NPI Number Information
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NPI Number | 1780985333
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE CLINIC, INC
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Dates
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Enumeration Date | 11/14/2010
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Last Update Date | 11/14/2010
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Provider Practice Location Address
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Address Line | 4203 RAINIER AVE S SUITE C
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City | SEATTLE
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State | WA
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Zip | 98118-1390
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Country | US
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Telephone | 206-721-2349
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Fax | 206-723-4321
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Provider Business Mailing Address
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Address Line | 4203 RAINIER AVE S SUITE C
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City | SEATTLE
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State | WA
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Zip | 98118-1390
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Country | US
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Telephone | 206-721-2349
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Fax | 206-723-4321
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KY VAN TRAN
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Credential | M.D.
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Telephone | 206-721-2349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 252-09 MD0023508
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License Number State | WA
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