Healthcare Provider Details

I. General information

NPI: 1801521208
Provider Name (Legal Business Name): ANDREW NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date: 05/04/2025
Reactivation Date: 06/18/2025

III. Provider practice location address

720 S 333RD ST
FEDERAL WAY WA
98003-7357
US

IV. Provider business mailing address

813 SW 318TH PL
FEDERAL WAY WA
98023-4744
US

V. Phone/Fax

Practice location:
  • Phone: 253-766-5156
  • Fax:
Mailing address:
  • Phone: 206-854-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: