Healthcare Provider Details

I. General information

NPI: 1316191331
Provider Name (Legal Business Name): LYNN PHUONG NGHIEM RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN PHUONG NGHIEM DH00006972

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7803 NE FOURTH PLN RD
VANCOUVER WA
98662-7294
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-768-9030
  • Fax: 360-768-9031
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4635
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00006972
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: