MEDICARE: MINH-TRIET DINH VO D.O.

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	207Q00000X	Family Medicine Physician	OP60674558	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DOL.OL.60379137	OTHER	WA	DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1235579038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH-TRIET DINH VO D.O.

Provider Business Mailing Address
First Line	:	9537 GRAVELLY LAKE DR SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-1513
Country	:	US
Telephone Number	:	253-984-2000
Fax Number	:	253-984-2049

Provider Business Practice Location Address
First Line	:	9537 GRAVELLY LAKE DR SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-1513
Country	:	US
Telephone Number	:	253-984-2000
Fax Number	:	253-984-2049

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	12/23/2016

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