Provider Demographics
NPI:1417040460
Name:TRAN, LLIEN MONG (MD)
Entity Type:Individual
Prefix:
First Name:LLIEN
Middle Name:MONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SLEATER KINNEY RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2316
Mailing Address - Country:US
Mailing Address - Phone:360-456-5541
Mailing Address - Fax:360-456-1268
Practice Address - Street 1:1202 SLEATER KINNEY RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2316
Practice Address - Country:US
Practice Address - Phone:360-456-5541
Practice Address - Fax:360-456-1268
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0022190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003540Medicaid
WA1003540Medicaid