Healthcare Provider Details

I. General information

NPI: 1417976440
Provider Name (Legal Business Name): LINH NGOC VU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 169TH ST S SUITE A
SPANAWAY WA
98387-8201
US

IV. Provider business mailing address

144 169TH ST S SUITE A
SPANAWAY WA
98387-8201
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-2824
  • Fax: 253-536-3070
Mailing address:
  • Phone: 253-536-2824
  • Fax: 253-536-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00037704
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: