Healthcare Provider Details

I. General information

NPI: 1104209006
Provider Name (Legal Business Name): LEM MINH NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10254 16TH AVE SW
SEATTLE WA
98146-1432
US

IV. Provider business mailing address

10254 16TH AVE SW
SEATTLE WA
98146-1432
US

V. Phone/Fax

Practice location:
  • Phone: 206-862-2573
  • Fax: 206-763-0291
Mailing address:
  • Phone: 206-862-2573
  • Fax: 206-763-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60569487
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60569487
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: