Healthcare Provider Details

I. General information

NPI: 1376470278
Provider Name (Legal Business Name): PHI KHANH NGOC NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 AIRPORT WAY S BLDG 12
SEATTLE WA
98134-2141
US

IV. Provider business mailing address

12823 OCCIDENTAL AVE S
BURIEN WA
98168-2626
US

V. Phone/Fax

Practice location:
  • Phone: 206-963-0633
  • Fax:
Mailing address:
  • Phone: 206-741-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA.70114028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: