Provider Demographics
NPI:1346393196
Name:TRAN, LYNN KIM (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:TRAN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:407 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2313
Mailing Address - Country:US
Mailing Address - Phone:213-680-3990
Mailing Address - Fax:213-626-7868
Practice Address - Street 1:407 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2313
Practice Address - Country:US
Practice Address - Phone:213-626-3589
Practice Address - Fax:213-626-7868
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16687Medicaid
CAPA16687OtherMEDICARE ID
CAPA16687OtherMEDICARE ID