Provider Demographics
NPI:1376857227
Name:TRAN, MY KIM (DDS)
Entity Type:Individual
Prefix:
First Name:MY
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7534 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4005
Mailing Address - Country:US
Mailing Address - Phone:703-754-1580
Mailing Address - Fax:
Practice Address - Street 1:7534 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4005
Practice Address - Country:US
Practice Address - Phone:703-754-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist