Healthcare Provider Details

I. General information

NPI: 1902527559
Provider Name (Legal Business Name): VY MY HANH CAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 124TH AVE NE
BELLEVUE WA
98005-2101
US

IV. Provider business mailing address

317 112TH AVE NE APT 708
BELLEVUE WA
98004-6571
US

V. Phone/Fax

Practice location:
  • Phone: 425-201-6261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61327616
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: