Healthcare Provider Details

I. General information

NPI: 1164336731
Provider Name (Legal Business Name): THANH VAN VO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LINCOLN ST 2ND FLOOR
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9900 LINCOLN ST 2ND FLOOR
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE70160333
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: