Healthcare Provider Details

I. General information

NPI: 1871828855
Provider Name (Legal Business Name): VANLY NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 TOTEM LAKE BLVD NE STE 102
KIRKLAND WA
98034-2901
US

IV. Provider business mailing address

6235 127TH AVE SE
BELLEVUE WA
98006-3942
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4455
  • Fax: 425-899-4434
Mailing address:
  • Phone: 856-291-1590
  • Fax: 920-206-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60852394
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56629-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: