Healthcare Provider Details

I. General information

NPI: 1043442932
Provider Name (Legal Business Name): NAM H NGUYEN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 TALBOT RD S
RENTON WA
98055-6219
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4055
  • Fax: 425-656-5425
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOP60450893
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: