Healthcare Provider Details

I. General information

NPI: 1891954293
Provider Name (Legal Business Name): HO DZUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST STE 102
TACOMA WA
98465-1628
US

IV. Provider business mailing address

3305 NASSAU ST
EVERETT WA
98201-4140
US

V. Phone/Fax

Practice location:
  • Phone: 206-538-6300
  • Fax: 206-538-6301
Mailing address:
  • Phone: 206-895-1825
  • Fax: 855-592-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13547
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD61140051
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13547
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: