Provider Demographics
NPI:1609181007
Name:TRAN, KIMNGAN PHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMNGAN
Middle Name:PHAM
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 PORT ARTHUR TER
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4257
Mailing Address - Country:US
Mailing Address - Phone:713-409-0442
Mailing Address - Fax:
Practice Address - Street 1:1112 PORT ARTHUR TER
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4656
Practice Address - Country:US
Practice Address - Phone:337-238-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207355207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ#39OtherST JOSEPH HOSTPITAL