Healthcare Provider Details

I. General information

NPI: 1053547232
Provider Name (Legal Business Name): DIEM-PHUONG NGOC TRAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 112TH ST SW
EVERETT WA
98204-4875
US

IV. Provider business mailing address

8609 EVERGREEN WAY
EVERETT WA
98208-2619
US

V. Phone/Fax

Practice location:
  • Phone: 425-551-6200
  • Fax: 425-551-6017
Mailing address:
  • Phone: 425-789-3700
  • Fax: 425-789-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL-3267
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60368373
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: