Healthcare Provider Details

I. General information

NPI: 1841516879
Provider Name (Legal Business Name): LAM PHUONG THI NGUYEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 3600
PUYALLUP WA
98372-4602
US

IV. Provider business mailing address

315 MARTIN L KING JR WAY
TACOMA WA
98405-4234
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-3480
  • Fax: 253-697-3490
Mailing address:
  • Phone: 253-697-3480
  • Fax: 253-697-3490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOP60642499
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOP60642499
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: