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NPI Code Detail

MEDICARE: DR. AI-KHUE THI NGUYEN M.D.

MEDICARE: DR. AI-KHUE THI NGUYEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD00044973WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1203361OTHERWAL&I
23386NGOTHERREGENCE BLUESHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
47107805OTHERAETNA

General Provider Information

NPI Number : 1104934629
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AI-KHUE THI NGUYEN M.D.
Provider Business Mailing Address
First Line : 1007 39TH AVE SE
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-2192
Country : US
Telephone Number : 253-435-3100
Fax Number : 253-435-3138
Provider Business Practice Location Address
First Line : 1007 39TH AVE SE
Second Line :
City : PUYALLUP
State : WA
Zip : 98374-2192
Country : US
Telephone Number : 253-435-3100
Fax Number : 253-435-3138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 04/28/2021

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