Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1275841249 |
---|---|
Provider Name | Kim Trinh Thi Tran |
First Address | Hillsboro, OR 97124-5802 |
Second Address | Hillboro, OR 97124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2010 |
Last Update Date | 23/09/2010 |