1851697072 NPI number — PHI-LAN HOANG NGUYEN L.AC, EAMP

Table of content: PHI-LAN HOANG NGUYEN L.AC, EAMP (NPI 1851697072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851697072 NPI number — PHI-LAN HOANG NGUYEN L.AC, EAMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
PHI-LAN
Provider Middle Name:
HOANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC, EAMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
Y LAN
Provider Other Middle Name:
HOANG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSAOM, EAMP, L.AC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851697072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12600 SE 38TH ST STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98006-6105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-679-6056
Provider Business Mailing Address Fax Number:
206-577-5375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12600 SE 38TH ST
Provider Second Line Business Practice Location Address:
STE. #130
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-6105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-679-6056
Provider Business Practice Location Address Fax Number:
206-577-5375
Provider Enumeration Date:
02/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC60205633 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AC60205633 . This is a "LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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