Provider Demographics
NPI:1558897272
Name:NGUYEN, NGOC THIEN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:NGOC THIEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 BRIDGEPORT WAY W STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8137
Mailing Address - Country:US
Mailing Address - Phone:253-581-2111
Mailing Address - Fax:253-581-7479
Practice Address - Street 1:7424 BRIDGEPORT WAY W STE 103
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8137
Practice Address - Country:US
Practice Address - Phone:253-581-2111
Practice Address - Fax:253-581-7479
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146642208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics