Basic Information
Provider Information
NPI: 1588059190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAN
FirstName: KEVIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2301 HOLMES ST
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641082640
CountryCode: US
TelephoneNumber: 8164044175
FaxNumber: 8164040003
Practice Location
Address1: 2301 HOLMES ST
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641082640
CountryCode: US
TelephoneNumber: 8164044175
FaxNumber: 8164040003
Other Information
ProviderEnumerationDate: 03/31/2015
LastUpdateDate: 01/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X2016018015MON Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X2018000530MOY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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