Provider Demographics
NPI:1487006318
Name:JAMES NGUYEN DMD PS
Entity Type:Organization
Organization Name:JAMES NGUYEN DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SON THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-774-9298
Mailing Address - Street 1:7935 216TH ST SW STE C
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7941
Mailing Address - Country:US
Mailing Address - Phone:425-774-9298
Mailing Address - Fax:425-778-5284
Practice Address - Street 1:7935 216TH ST SW STE C
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7941
Practice Address - Country:US
Practice Address - Phone:425-774-9298
Practice Address - Fax:425-778-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE85421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1134292238OtherCENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)