Provider Demographics
NPI:1093595977
Name:NGUYEN, LINH
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 LAKE CITY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4206
Mailing Address - Country:US
Mailing Address - Phone:703-628-4775
Mailing Address - Fax:
Practice Address - Street 1:1214 SW SCOTTON WAY
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-2715
Practice Address - Country:US
Practice Address - Phone:360-843-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614822121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice