Healthcare Provider Details

I. General information

NPI: 1558897272
Provider Name (Legal Business Name): NGOC THIEN NGUYEN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S CUSHMAN AVE
TACOMA WA
98405-3631
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-2144
  • Fax: 253-246-6725
Mailing address:
  • Phone: 536-266-6262
  • Fax: 253-581-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61032678
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA146642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: