Provider Demographics
NPI:1508927716
Name:NGUYEN, SON VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SON
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16340 75TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4913
Mailing Address - Country:US
Mailing Address - Phone:425-741-9179
Mailing Address - Fax:425-741-9179
Practice Address - Street 1:7101 MARTIN LUTHER KING JR WAY S
Practice Address - Street 2:#217
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3594
Practice Address - Country:US
Practice Address - Phone:206-722-7786
Practice Address - Fax:206-722-7884
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104140Medicaid
WAAB04375Medicare ID - Type Unspecified
WAG24524Medicare UPIN