MEDICARE: DR. BAO N DINH 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	207Q00000X	Family Medicine Physician	ME155152	FL
2	207Q00000X	Family Medicine Physician	MD61474283	WA
3	208VP0014X	Interventional Pain Medicine Physician	ME155152	FL

General Provider Information

NPI Number	:	1881252229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAO N DINH MD

Provider Business Mailing Address
First Line	:	6753 PARK ST E
Second Line	:
City	:	FIFE
State	:	WA
Zip	:	98424-3828
Country	:	US
Telephone Number	:	305-284-7761
Fax Number	:

Provider Business Practice Location Address
First Line	:	4626 MLK JR WAY S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-2135
Country	:	US
Telephone Number	:	206-721-8000
Fax Number	:

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

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	11/07/2023

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