Basic Information
| Provider Information | |||||||||
| NPI: | 1023614104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | MY KIM | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14842 DORRAY LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770821756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132988479 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13480 VETERANS MEMORIAL DR STE R1 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770141670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815871600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2020 | ||||||||
| LastUpdateDate: | 12/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | PA14048 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.