1285343772 NPI number — DR. TRACY MY TUYEN TANG PHARMD

Table of content: DR. TRACY MY TUYEN TANG PHARMD (NPI 1285343772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285343772 NPI number — DR. TRACY MY TUYEN TANG PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANG
Provider First Name:
TRACY
Provider Middle Name:
MY TUYEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1285343772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17631 21ST AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98037-5328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-678-2356
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BELLEVUE WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-5718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-749-3889
Provider Business Practice Location Address Fax Number:
425-749-3890
Provider Enumeration Date:
11/23/2022

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: 183500000X , with the licence number:  PH61324207 , 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)





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