Healthcare Provider Details

I. General information

NPI: 1538349550
Provider Name (Legal Business Name): ANN A DARANOUVONG DH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANONGPHONE DARANOUVONG DH

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S STE 100
SEATTLE WA
98104-3033
US

IV. Provider business mailing address

PO BOX 24911
SEATTLE WA
98124-0911
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3700
  • Fax:
Mailing address:
  • Phone: 206-788-3600
  • Fax: 206-652-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00006905
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: