Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60500570 | WA |
NPI | 1003257619 |
---|---|
Provider Name | Dr. Tim C. Tran |
First Address | Tukwila, WA 98188-2923 |
Second Address | Tukwila, WA 98188-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 05/02/2019 |