Healthcare Provider Details

I. General information

NPI: 1538633664
Provider Name (Legal Business Name): TRANG PHUNG CH61614560
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PIKE ST STE 210
SEATTLE WA
98101-2010
US

IV. Provider business mailing address

104 PIKE ST STE 210
SEATTLE WA
98101-2010
US

V. Phone/Fax

Practice location:
  • Phone: 206-623-2225
  • Fax:
Mailing address:
  • Phone: 206-623-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61614560
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN60543719
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: