MEDICARE: MS. KIM VI TRAN RN, APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.015696	IL

General Provider Information

NPI Number	:	1891235230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM VI TRAN RN, APN

Provider Business Mailing Address
First Line	:	474 N LAKE SHORE DR
Second Line	:	UNIT 4601
City	:	CHICAGO
State	:	IL
Zip	:	60611-3400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 N LAKE SHORE DR
Second Line	:	UNIT 4601
City	:	CHICAGO
State	:	IL
Zip	:	60611-3400
Country	:	US
Telephone Number	:	312-823-6711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2017
Last Update Date	:	03/05/2017

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