Provider Demographics
NPI:1891888533
Name:TRAN-BERGMAN, KIKI HOANG (DPM)
Entity type:Individual
Prefix:DR
First Name:KIKI
Middle Name:HOANG
Last Name:TRAN-BERGMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MEMORIAL HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4573
Mailing Address - Country:US
Mailing Address - Phone:813-249-5050
Mailing Address - Fax:813-358-3582
Practice Address - Street 1:6301 MEMORIAL HWY STE 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4573
Practice Address - Country:US
Practice Address - Phone:813-249-5050
Practice Address - Fax:813-358-3582
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3059213E00000X
FLPO 3059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340404800Medicaid
FLU96127Medicare UPIN
FLU1029AMedicare ID - Type Unspecified