Healthcare Provider Details

I. General information

NPI: 1992408488
Provider Name (Legal Business Name): ANGELA THUY TIEN NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 08/07/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone: 206-987-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61425930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: