MEDICARE: MRS. LYNN PHUONG NGHIEM RDH

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	124Q00000X	Dental Hygienist	H4635	OR
2	124Q00000X	Dental Hygienist	DH00006972	WA

General Provider Information

NPI Number	:	1316191331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN PHUONG NGHIEM RDH

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7803 NE FOURTH PLN RD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-7294
Country	:	US
Telephone Number	:	360-768-9030
Fax Number	:	360-768-9031

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

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/07/2022

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