Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401415997 | VA |
NPI | 1083093231 |
---|---|
Provider Name | Kimberly P Tran |
First Address | Miami, FL 33155-3009 |
Second Address | Charlottesville, VA 22911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 07/06/2018 |