Healthcare Provider Details

I. General information

NPI: 1912844630
Provider Name (Legal Business Name): NAM PHUONG HOANG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 MILITARY RD S STE 200
TUKWILA WA
98168-3001
US

IV. Provider business mailing address

13030 MILITARY RD S STE 200
TUKWILA WA
98168-3001
US

V. Phone/Fax

Practice location:
  • Phone: 206-439-3289
  • Fax: 206-439-3289
Mailing address:
  • Phone: 206-439-3289
  • Fax: 206-439-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number61619762
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: