Provider Demographics
NPI:1841407202
Name:TRAN, KHIEM QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:KHIEM
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7306 MAPLE PL
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3005
Mailing Address - Country:US
Mailing Address - Phone:330-615-3205
Mailing Address - Fax:330-615-3221
Practice Address - Street 1:7306 MAPLE PL
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3005
Practice Address - Country:US
Practice Address - Phone:703-333-5001
Practice Address - Fax:703-333-5087
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101244421OtherLICENSE
VA1841407202Medicaid
VA506871ZVC8Medicare PIN