Healthcare Provider Details

I. General information

NPI: 1730735382
Provider Name (Legal Business Name): QUANG KHONG MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E YESLER WAY
SEATTLE WA
98122-5640
US

IV. Provider business mailing address

28057 39TH AVE S
AUBURN WA
98001-1337
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-6503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: