Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 30108 | KS |
NPI | 1124037387 |
---|---|
Provider Name | Joanna M Tran |
First Address | Wichita, KS 67218-1607 |
Second Address | Wichita, KS 67218-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 02/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100456070A | (05) | KS |
102933 | BCBS (01) | KS |
103696 | HPK (01) | KS |
12149486 | MULTIPLAN (01) | KS |
165074 | COVENTRY (01) | KS |
6696 | PHS (01) | KS |
H85265 | (02) |