Provider Demographics
NPI:1629682281
Name:TRAN, LAN KIM
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SE 202ND CT
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8668
Mailing Address - Country:US
Mailing Address - Phone:360-844-6270
Mailing Address - Fax:360-844-6270
Practice Address - Street 1:909 SE 202ND CT
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8668
Practice Address - Country:US
Practice Address - Phone:360-844-6270
Practice Address - Fax:360-844-6270
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC55963171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter