MEDICARE: DR. PHONG NGHIEU BUI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00009093	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407912033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHONG NGHIEU BUI DDS

Provider Business Mailing Address
First Line	:	1640 DUVALL AVE NE STE 201
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98059-3985
Country	:	US
Telephone Number	:	425-235-4950
Fax Number	:	425-235-4989

Provider Business Practice Location Address
First Line	:	1640 DUVALL AVE NE STE 201
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98059-3985
Country	:	US
Telephone Number	:	425-235-4950
Fax Number	:	425-235-4989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	04/12/2026

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