Provider Demographics
NPI:1114012507
Name:TRAN, KY V (MD)
Entity Type:Individual
Prefix:DR
First Name:KY
Middle Name:V
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4203 RAINIER AVENUE, SOUTH
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1390
Mailing Address - Country:US
Mailing Address - Phone:206-721-2349
Mailing Address - Fax:206-723-4321
Practice Address - Street 1:4203 RAINIER AVENUE, SOUTH
Practice Address - Street 2:SUITE C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1390
Practice Address - Country:US
Practice Address - Phone:206-721-2349
Practice Address - Fax:206-723-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252-09 MD0023508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016286Medicaid
WA1016286Medicaid
WA000106453-01Medicare ID - Type Unspecified