Healthcare Provider Details

I. General information

NPI: 1780994400
Provider Name (Legal Business Name): JESSICA V NGUYEN DDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 140TH AVE NE
BELLEVUE WA
98005-2972
US

IV. Provider business mailing address

PO BOX 3007
SEATTLE WA
98114-3007
US

V. Phone/Fax

Practice location:
  • Phone: 425-373-3030
  • Fax: 206-652-5216
Mailing address:
  • Phone: 206-788-3757
  • Fax: 206-652-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61048710
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: