Healthcare Provider Details

I. General information

NPI: 1134778681
Provider Name (Legal Business Name): HIEP NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MISSION AVE
SPOKANE WA
99201-2358
US

IV. Provider business mailing address

120 W MISSION AVE
SPOKANE WA
99201-2358
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-4343
  • Fax:
Mailing address:
  • Phone: 509-543-4343
  • Fax: 509-329-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61111959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: