Provider Demographics
NPI:1083147862
Name:LA, KIET TUAN (MD)
Entity Type:Individual
Prefix:
First Name:KIET
Middle Name:TUAN
Last Name:LA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KIET
Other - Middle Name:TUAN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10987 SHELDON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4702
Mailing Address - Country:US
Mailing Address - Phone:813-467-4800
Mailing Address - Fax:813-467-4252
Practice Address - Street 1:10987 SHELDON RD STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4702
Practice Address - Country:US
Practice Address - Phone:813-467-4800
Practice Address - Fax:813-467-4252
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME137806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program