Healthcare Provider Details

I. General information

NPI: 1952550360
Provider Name (Legal Business Name): QUYNH DH NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24722 104TH AVE SE
KENT WA
98030-5322
US

IV. Provider business mailing address

827 128TH ST SW STE A
EVERETT WA
98204-5321
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-2182
  • Fax: 253-854-2435
Mailing address:
  • Phone: 425-290-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60035248
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: