Provider Demographics
NPI:1508825449
Name:NGUYEN, HA QUANG (DPM)
Entity Type:Individual
Prefix:DR
First Name:HA
Middle Name:QUANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 S 11TH ST
Mailing Address - Street 2:BLDG 2
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4099
Mailing Address - Country:US
Mailing Address - Phone:253-272-0606
Mailing Address - Fax:253-272-2118
Practice Address - Street 1:1206 S 11TH ST
Practice Address - Street 2:BLDG 2
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4099
Practice Address - Country:US
Practice Address - Phone:253-272-0606
Practice Address - Fax:253-272-2118
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122399Medicaid
WA8855671Medicare ID - Type UnspecifiedPODIATRY
WA1122399Medicaid
WAG8875029Medicare PIN