Provider Demographics
NPI:1508853003
Name:TA, KENT THIEN (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:THIEN
Last Name:TA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THIEN
Other - Middle Name:TRAN
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1380 112TH AVE NE STE 202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3759
Mailing Address - Country:US
Mailing Address - Phone:425-590-9521
Mailing Address - Fax:425-590-9574
Practice Address - Street 1:1380 112TH AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:425-590-9521
Practice Address - Fax:425-590-9574
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040870207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8390346Medicaid
WA3247TAOtherREGENCE
WA186101OtherL I
WAP00337140OtherPALMETTO RR MEDICARE
WA5891740001OtherDME
I03671Medicare UPIN
WA5891740001OtherDME