Healthcare Provider Details

I. General information

NPI: 1568557551
Provider Name (Legal Business Name): VINA CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 MARTIN LUTHER KING JR. WAY S. 216
SEATTLE WA
98118
US

IV. Provider business mailing address

7101 MARTIN LUTHER KING JR. WAY S. 216
SEATTLE WA
98118
US

V. Phone/Fax

Practice location:
  • Phone: 206-721-3589
  • Fax: 206-721-8900
Mailing address:
  • Phone: 206-721-3589
  • Fax: 206-721-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 8374
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 9079
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN 188
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE8865
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE9349
License Number StateWA

VIII. Authorized Official

Name: MR. THU VAN NGUYEN
Title or Position: PRESIDENT
Credential: L.D.
Phone: 206-721-3589