Provider Demographics
NPI:1346691920
Name:THACH, SOMENAN NGOC
Entity Type:Individual
Prefix:
First Name:SOMENAN
Middle Name:NGOC
Last Name:THACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC STREET H362 HEALTH
Mailing Address - Street 2:SCIENCES BUILDING, BOX 357631
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6650
Mailing Address - Country:US
Mailing Address - Phone:562-822-7489
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC STREET H362 HEALTH
Practice Address - Street 2:SCIENCES BUILDING, BOX 357631
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6650
Practice Address - Country:US
Practice Address - Phone:206-543-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60598678390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program