Healthcare Provider Details

I. General information

NPI: 1588107338
Provider Name (Legal Business Name): NGHIA HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 NE CAMPUS PKWY
SEATTLE WA
98195-7630
US

IV. Provider business mailing address

16405 27TH STREET CT E
LAKE TAPPS WA
98391-9678
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-6788
  • Fax:
Mailing address:
  • Phone: 206-349-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberIR60602871
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61100246
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: