Provider Demographics
NPI:1548716152
Name:NGUYEN, PHANDINH NGOC (ND, MD)
Entity type:Individual
Prefix:DR
First Name:PHANDINH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:ND, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SW 43RD ST STE L
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4900
Mailing Address - Country:US
Mailing Address - Phone:425-324-4745
Mailing Address - Fax:253-981-4815
Practice Address - Street 1:330 SW 43RD ST,SUITE L
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-324-4745
Practice Address - Fax:253-981-4815
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60616795175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2061470Medicaid