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General NPI Number Information
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NPI Number | 1407896806
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Entity Type | Organization
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Legal Business Name | OVERLAKE INTERNAL MEDICINE ASSOCIATES INC PS
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 1407 116TH AVE NE SUITE 200
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City | BELLEVUE
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State | WA
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Zip | 98004-3819
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Country | US
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Telephone | 425-990-5222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5845
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City | PORTLAND
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State | OR
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Zip | 97228-5845
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Country | US
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Telephone | 425-454-5281
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Fax | 425-990-5261
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Authorized Official
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Title or Position | CEO
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Name | NGHIA GIANG
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Credential |
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Telephone | 425-974-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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