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General NPI Number Information
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NPI Number | 1306251509
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Entity Type | Individual
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Provider Name | KENNETH TANTHANH NGUYEN D.O., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 2811 S 102ND ST STE 220
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City | TUKWILA
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State | WA
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Zip | 98168-1869
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Country | US
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Telephone | 206-320-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 S 102ND ST STE 220
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City | TUKWILA
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State | WA
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Zip | 98168-1869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | BP10050257
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP61088631
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License Number State | WA
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