1578638672 NPI number — NGA ANH DUONG DMD

Table of content: NGA ANH DUONG DMD (NPI 1578638672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578638672 NPI number — NGA ANH DUONG DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUONG
Provider First Name:
NGA
Provider Middle Name:
ANH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1578638672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21105 SR 401E
Provider Second Line Business Mailing Address:
SUITE G4
Provider Business Mailing Address City Name:
BONNEY LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-299-6730
Provider Business Mailing Address Fax Number:
253-862-8921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21105 SR 410 E
Provider Second Line Business Practice Location Address:
SUITE G-4
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-8457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-299-6730
Provider Business Practice Location Address Fax Number:
253-862-8921
Provider Enumeration Date:
11/22/2006

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: 122300000X , with the licence number:  BD9843803 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 5175 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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