Healthcare Provider Details

I. General information

NPI: 1174527683
Provider Name (Legal Business Name): VIRGINIA MASON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NINTH AVE MS: C1-PO
SEATTLE WA
98101
US

IV. Provider business mailing address

1100 NINTH AVE MS: C1-PO
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6877
  • Fax: 206-223-7606
Mailing address:
  • Phone: 206-223-6877
  • Fax: 206-223-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number262010301062
License Number StateWA

VIII. Authorized Official

Name: MR. HUNG VAN TRUONG
Title or Position: MANAGER
Credential: PHARMD
Phone: 206-341-0550