Healthcare Provider Details

I. General information

NPI: 1821783572
Provider Name (Legal Business Name): CINDY KIM NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 301
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

450 N GRAHAM ST
PORTLAND OR
97227-1682
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7374
  • Fax: 360-514-7384
Mailing address:
  • Phone: 503-413-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA215967
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number70045370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: