1669046108 NPI number — HIEU THI KIM NGUYEN

Table of content: HIEU THI KIM NGUYEN (NPI 1669046108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669046108 NPI number — HIEU THI KIM NGUYEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
HIEU
Provider Middle Name:
THI KIM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1669046108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15115 NE 96TH ST, VANCOUVER
Provider Second Line Business Mailing Address:
VANCOUVER
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-718-8783
Provider Business Mailing Address Fax Number:
360-718-8783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15115 NE 96TH ST
Provider Second Line Business Practice Location Address:
VANCOUVER
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-718-8783
Provider Business Practice Location Address Fax Number:
360-718-8783
Provider Enumeration Date:
05/19/2021

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: 163W00000X , with the licence number:  RN60650979 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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