Healthcare Provider Details

I. General information

NPI: 1568683969
Provider Name (Legal Business Name): THU VAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 MARTIN LUTHER KING JR WAY S STE 216
SEATTLE WA
98118-3592
US

IV. Provider business mailing address

7101 MARTIN LUTHER KING JR WAY S STE 216
SEATTLE WA
98118-3592
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN188
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: