Healthcare Provider Details

I. General information

NPI: 1306661046
Provider Name (Legal Business Name): MRS. HUYEN BAO NGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 28TH AVENUE CT SW
PUYALLUP WA
98373-1362
US

IV. Provider business mailing address

1925 28TH AVENUE CT SW
PUYALLUP WA
98373-1362
US

V. Phone/Fax

Practice location:
  • Phone: 425-998-3191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number12180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: