Healthcare Provider Details

I. General information

NPI: 1033816533
Provider Name (Legal Business Name): MINH THANH DUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JASON MINHTHANH DUONG

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 112TH AVE NE STE C186
BELLEVUE WA
98004-3749
US

IV. Provider business mailing address

12225 NE 5TH ST APT B304
BELLEVUE WA
98005-4814
US

V. Phone/Fax

Practice location:
  • Phone: 425-827-5877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.61671137
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: