Provider Demographics
NPI:1306361134
Name:TRAN, TINA CAM-NGA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:CAM-NGA
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 BRONSON WAY N STE 120
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5727
Mailing Address - Country:US
Mailing Address - Phone:425-271-4543
Mailing Address - Fax:425-277-7419
Practice Address - Street 1:1222 BRONSON WAY N STE 120
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5727
Practice Address - Country:US
Practice Address - Phone:425-271-4543
Practice Address - Fax:425-277-7419
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60769473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist