Healthcare Provider Details

I. General information

NPI: 1578127478
Provider Name (Legal Business Name): KATHY PHUONG NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 2ND ST SW STE 140
AUBURN WA
98001-5203
US

IV. Provider business mailing address

4205 SW 337TH PL
FEDERAL WAY WA
98023-3200
US

V. Phone/Fax

Practice location:
  • Phone: 253-737-5078
  • Fax: 253-216-2821
Mailing address:
  • Phone: 206-883-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: