Healthcare Provider Details

I. General information

NPI: 1407374325
Provider Name (Legal Business Name): TIEN DO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/21/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 11TH AVE NE STE 200
SEATTLE WA
98105-6367
US

IV. Provider business mailing address

PO BOX 5517
PORTLAND OR
97228-5517
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-4001
  • Fax: 206-616-3889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: