Provider Demographics
NPI:1417158833
Name:TRAN, KIEN T (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KIEN
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601799
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75360-1799
Mailing Address - Country:US
Mailing Address - Phone:214-893-9677
Mailing Address - Fax:972-475-5303
Practice Address - Street 1:6800 HERITAGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8746
Practice Address - Country:US
Practice Address - Phone:972-475-5300
Practice Address - Fax:972-475-5303
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3356207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA61670OtherGEORGIA MEDICAL LICENSE
BP1-0026121OtherINSTITUTIONAL PERMIT
TXN3356OtherTEXAS MEDICAL LICENSE
FT1684465OtherDEA NUMBER