Healthcare Provider Details

I. General information

NPI: 1932121381
Provider Name (Legal Business Name): DAT NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

IV. Provider business mailing address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

V. Phone/Fax

Practice location:
  • Phone: 360-651-4525
  • Fax: 360-651-9427
Mailing address:
  • Phone: 360-651-4525
  • Fax: 360-651-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00033474
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: