Healthcare Provider Details

I. General information

NPI: 1619292596
Provider Name (Legal Business Name): OVERLAKE SLEEP DISORDERS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 112TH AVE NE SUITE 320
BELLEVUE WA
98004-4511
US

IV. Provider business mailing address

1100 112TH AVE NE SUITE 320
BELLEVUE WA
98004-4511
US

V. Phone/Fax

Practice location:
  • Phone: 425-289-3000
  • Fax: 425-289-3240
Mailing address:
  • Phone: 425-289-3000
  • Fax: 425-289-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NGHIA GIANG
Title or Position: CEO
Credential:
Phone: 425-974-7601