MEDICARE: DR. PEARL NGOC NGUYEN MD

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
1	208000000X	Pediatrics Physician	MD70029008	WA

General Provider Information

NPI Number	:	1184373813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEARL NGOC NGUYEN MD

Provider Business Mailing Address
First Line	:	3939 S OTHELLO ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3505
Country	:	US
Telephone Number	:	206-987-7210
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 S OTHELLO ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3505
Country	:	US
Telephone Number	:	206-987-7210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	09/17/2025

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