Healthcare Provider Details

I. General information

NPI: 1306427836
Provider Name (Legal Business Name): THOMAS QUOC BAO NGUYEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 NE 33RD PL STE 202
BELLEVUE WA
98004-1444
US

IV. Provider business mailing address

3123 148TH ST SW UNIT H4
LYNNWOOD WA
98087-5994
US

V. Phone/Fax

Practice location:
  • Phone: 888-674-5871
  • Fax:
Mailing address:
  • Phone: 308-385-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA61144140
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: