Provider Demographics
NPI:1568046977
Name:PHI, TRAN (DMD)
Entity Type:Individual
Prefix:
First Name:TRAN
Middle Name:
Last Name:PHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5523 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2440
Mailing Address - Country:US
Mailing Address - Phone:206-834-5867
Mailing Address - Fax:
Practice Address - Street 1:20011 BALLINGER WAY NE STE B-100
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1286
Practice Address - Country:US
Practice Address - Phone:206-946-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61170746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist