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General NPI Number Information
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NPI Number | 1851130975
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Entity Type | Individual
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Provider Name | KEVIN LY TRAN
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Gender | Male
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 210 E GRAY ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-3900
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Country | US
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Telephone | 502-584-7525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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