Provider Demographics
NPI:1275199002
Name:TRAN, THE KIM (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:THE
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 WINDSOR CENTRE TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1983
Mailing Address - Country:US
Mailing Address - Phone:469-635-5990
Mailing Address - Fax:
Practice Address - Street 1:4335 WINDSOR CENTRE TRL STE 110
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1983
Practice Address - Country:US
Practice Address - Phone:469-635-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant