Healthcare Provider Details

I. General information

NPI: 1972331650
Provider Name (Legal Business Name): JORDAN MINH KHANG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

IV. Provider business mailing address

914 110TH PL SE
EVERETT WA
98208-4010
US

V. Phone/Fax

Practice location:
  • Phone: 206-695-7600
  • Fax: 206-695-7606
Mailing address:
  • Phone: 425-268-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: