Provider Demographics
NPI:1093799678
Name:NGAI, JENNIFER PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PHUONG
Last Name:NGAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 212TH ST SW
Mailing Address - Street 2:SUITE 112C
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7565
Mailing Address - Country:US
Mailing Address - Phone:425-776-8353
Mailing Address - Fax:425-776-7173
Practice Address - Street 1:7631 212TH ST SW
Practice Address - Street 2:SUITE 112C
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7565
Practice Address - Country:US
Practice Address - Phone:425-776-8353
Practice Address - Fax:425-776-7173
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA72721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5019419Medicaid