MEDICARE: DIEM TRUONG KIEU NGUYEN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1568829380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEM TRUONG KIEU NGUYEN

Provider Business Mailing Address
First Line	:	1600 E OLIVE ST
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98122-2735
Country	:	US
Telephone Number	:	206-320-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	400 YESLER WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2683
Country	:	US
Telephone Number	:	206-302-2820
Fax Number	:

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

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	01/25/2016

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Directions to “ DIEM TRUONG KIEU NGUYEN ” Practice Location

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