Provider Demographics
NPI:1699152397
Name:TRAN, KIM VAN (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 140TH AVE NE BLDG C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1892
Mailing Address - Country:US
Mailing Address - Phone:425-828-2257
Mailing Address - Fax:
Practice Address - Street 1:2475 140TH AVE NE BLDG C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1892
Practice Address - Country:US
Practice Address - Phone:425-828-2257
Practice Address - Fax:425-896-7034
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61457390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics