Provider Demographics
NPI:1568557551
Name:VINA CLINIC INC.
Entity Type:Organization
Organization Name:VINA CLINIC INC.
Other - Org Name:VINA DENTAL & DENTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THU
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:206-721-3589
Mailing Address - Street 1:7101 MARTIN LUTHER KING JR. WAY S.
Mailing Address - Street 2:216
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118
Mailing Address - Country:US
Mailing Address - Phone:206-721-3589
Mailing Address - Fax:206-721-8900
Practice Address - Street 1:7101 MARTIN LUTHER KING JR. WAY S.
Practice Address - Street 2:216
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118
Practice Address - Country:US
Practice Address - Phone:206-721-3589
Practice Address - Fax:206-721-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 8374122300000X
WADE 9079122300000X
WADE8865122300000X
WADE9349122300000X
WADN 188122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered122400000XDental ProvidersDenturistGroup - Single Specialty