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General NPI Number Information
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NPI Number | 1457923252
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Entity Type | Individual
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Provider Name | KHA VU NGUYEN NGUYEN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 4311 NE SUNSET BLVD
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City | RENTON
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State | WA
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Zip | 98059-4011
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Country | US
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Telephone | 425-235-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 17202 AURORA AVE N APT 525
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City | SHORELINE
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State | WA
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Zip | 98133-5359
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Country | US
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Telephone | 253-282-3990
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61179107
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License Number State | WA
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