Provider Demographics
NPI:1013963255
Name:TRAN, VAN T (DO)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:6511 JOHNSON DRIVE
Practice Address - Street 2:MISSION FAMILY HEALTH CARE
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205
Practice Address - Country:US
Practice Address - Phone:913-261-3300
Practice Address - Fax:913-261-3317
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-28736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
25020041OtherBCBS PROVIDER NUMBER
25562039OtherBCBS KUMW UC
3732660OtherAETNA KUMW UC
080172745OtherRR MEDICARE
2107651OtherAETNA
357581OtherFIRSTGUARD KUMW UC
481159444OtherJAYHAWK TAX ID
157695XXOtherPREFERRED CARE OF NY
10001635900OtherCHP PROVIDER NUMBER
KS100391560AMedicaid
481159444OtherJAYHAWK TAX ID
157695XXOtherPREFERRED CARE OF NY