1932465051 NPI number — DR. TIMOTHY WEN-ZEN NG MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932465051 NPI number — DR. TIMOTHY WEN-ZEN NG MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NG

Provider First Name:

TIMOTHY

Provider Middle Name:

WEN-ZEN

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1932465051

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/04/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

19020 33RD AVE W

Provider Second Line Business Mailing Address:

STE 210

Provider Business Mailing Address City Name:

LYNNWOOD

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98036-4748

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

425-563-1500

Provider Business Mailing Address Fax Number:

425-563-1374

Provider First Line Business Practice Location Address:

2211 NE 139TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

VANCOUVER

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98686-2742

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

360-566-4840

Provider Business Practice Location Address Fax Number:

360-566-4842

Provider Enumeration Date:

04/03/2012

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  R3563 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 5896 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: MD61156917 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0438346 . This is a "L & I - RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0438364 . This is a "L & I - SEATTLE RADIOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0438356 . This is a "L & I - EVERGREEN RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 2179012 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0438348 . This is a "L & I - RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0438350 . This is a "L & I - SWEDISH RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0438365 . This is a "L & I - VANCOUVER RADIOLOGISTS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 0438368 . This is a "L & I - SOUTH SOUND RADIOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".