Provider Demographics
NPI:1558464198
Name:DAVID NGUYEN MD PS INC
Entity Type:Organization
Organization Name:DAVID NGUYEN MD PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-860-0288
Mailing Address - Street 1:2120 RAINIER AVE S
Mailing Address - Street 2:#C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:206-860-0288
Mailing Address - Fax:206-328-0489
Practice Address - Street 1:2120 RAINIER AVE S
Practice Address - Street 2:#C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-860-0288
Practice Address - Fax:206-328-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116490Medicaid
WA1116490Medicaid
WA8803116Medicare ID - Type UnspecifiedGROUP ID NUMBER