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General NPI Number Information
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NPI Number | 1649527987
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Entity Type | Individual
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Provider Name | PHU HOANG DUC NGO PA
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Gender | Male
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 4400 37TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-1609
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Country | US
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Telephone | 206-461-6957
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Fax | 206-461-7810
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Provider Business Mailing Address
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Address Line | 2217 152ND AVE NE, SUITE 100
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City | REDMOND
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State | WA
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Zip | 98052-9805
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Country | US
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Telephone | 425-825-3900
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Fax | 425-821-2549
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60305256
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License Number State | WA
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