Provider Demographics
NPI:1992835607
Name:TRAN, THERESA N (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:N
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-4707
Practice Address - Street 1:660 SW 39TH ST
Practice Address - Street 2:STE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4912
Practice Address - Country:US
Practice Address - Phone:425-793-4700
Practice Address - Fax:425-656-4046
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60013216207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093354Medicaid
WA0039581OtherINDIVIDUAL L&I NUMBER
WAG8874715Medicare PIN