MEDICARE: NGAN PHAN KIEU TRAN 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

General Provider Information

NPI Number	:	1417519224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGAN PHAN KIEU TRAN RDH

Provider Business Mailing Address
First Line	:	4513 S HOLDEN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-4119
Country	:	US
Telephone Number	:	425-301-3409
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 8TH AVE S STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-3034
Country	:	US
Telephone Number	:	206-788-3700
Fax Number	:

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

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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