MEDICARE: THERESA H.T. NGUYEN PLLC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO60335864	WA

General Provider Information

NPI Number	:	1649708819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESA H.T. NGUYEN PLLC

Provider Business Mailing Address
First Line	:	15761 NORTHUP WAY
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2555
Country	:	US
Telephone Number	:	425-283-3709
Fax Number	:

Provider Business Practice Location Address
First Line	:	17530 NE UNION HILL RD STE 110
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98052-3340
Country	:	US
Telephone Number	:	425-283-3709
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	DR. THERESA H.T. NGUYEN
Credential	:	DPM
Telephone Number	:	425-283-3709

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	05/31/2017

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