Healthcare Provider Details

I. General information

NPI: 1417694522
Provider Name (Legal Business Name): HANNAH KRISTINE VUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TAHOMA BLVD UNIT 102
YELM WA
98597-7735
US

IV. Provider business mailing address

525 LILLY RD NE STE 204
OLYMPIA WA
98506-5101
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-7761
  • Fax: 360-706-1183
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61571406
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: