Basic Information
| Provider Information | |||||||||
| NPI: | 1215279104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053289200 | ||||||||
| FaxNumber: | 6053289201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1621 S MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053289200 | ||||||||
| FaxNumber: | 6053289201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME131050 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 11346 | SD | N | 207WX0107X | ME131050 | FL | N | 207W00000X | 11346 | SD | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.